Stop Prolonged and Unnecessary Medical Procedures....(Achieving a consensus on the right care for our elderly)

(This was sent to ST Forum Page but was unpublished.  I think it is relevant in view of the many things happening to our healthcare system : - overcrowding in hospitals; high medical costs; untold pains of both patients and loved ones caused by risky and unnecessary medical procedures)

The medical care of an elderly patient is a complex one involving both clinical and non clinical considerations.This arises from the interactions amongst patient, loved ones and physician  - each with at times differing intentions.  I therefore agree that the highest level of care and comfort should form the paramount basis for any and every decision.  The ultimate goal must be to help patients regain a reasonable level of functions - physically, mentally and emotionally.    

In many surveys, elderly patients have indicated that they wish to spend their time (particularly the final hours at home where care should be made available.  I think it is laudable that finally, efforts are being made to review the use of CPF for palliative care, and more resources (hopefully without too much bureaucratic delays) are being planned to invest in home care training of professionals etc.

The wishes of patients and their primary care givers should always take precedence. These must be determined at the outset. Since the clinical inputs of professionals are important, it is therefore vital that a comprehensive discussion of any recommendations pertaining to medical procedures be conducted before any action is taken. Such discussions should cover clinical as well as post procedural care and living condition. In the event that there is a conflict of opinions regarding the options for the patients - their wishes or those of their loved ones must prevail. This is to prevent decisions that will result in unnecessary pain to the patients, undue anguish to loved ones and financial hardship to the families. 

The advice of physicians while to be respected must be subserved to those of the patients and their loved ones.  Physicians should also be wary not to draw exceedingly alarmist scenarios that present loved ones or patients with only dire outcomes that force their hands on some of these decisions.   

I feel very strongly that patients, their caregivers and loved ones should begin to take responsibility for medical decisions.  I have heard of too many sad cases when these were prevailed by professionals at the expense of the dignity, care and comfort of patients

Care of our elderly Mum

I am writing this to help those who have to look after their elderly parents  (frankly most of us would have this opportunity sometime in life).  Our elderly parents are individuals and they are all different.  However, certain aspects of care for them should be quite universal.  I hope this post will start a conversation and sharing amongst friends and others who are in similar situations.  Through it, we make our collective journey more bearable and theirs, easier too.   

Mum's medical history- a hypoglycemia (low sugar level) episode

Mum is 84 years old.  She has had a few hospitalizations lately - mainly for infections of the urinary tract/kidneys etc.  She has been a diabetic since her 40s - we are grateful that with her underlying conditions, she is in the main good for her age.

This is in large part due to Dad's meticulous care - after she had a hypo episode when I was in my late 20s. I still remember vividly what happened. While sleeping late one Saturday morning, I was awoken by a commotion in the kitchen.  Dad was washing a small towel at the sink. Mum was sitting on a chair - extremely pale and had a deep cut on her forehead.

Dad told me Mum fell and hit the raising on the floor of the kitchen.  I changed and quickly brought her to her doctor.  She had apparently not been monitoring and had low sugar.  One of the more serious symptoms is fainting spells and the worst is of course shock and death.

Anyway, after the scare - Dad took it upon himself to very closely monitor Mum's medications and conditions.  Of course Mum had a few other health issues during those years - she had diabetic retinopathy - bleeding of the veins in her eyes (which if untreated would have caused blindness).  Her diabetes was so badly managed earlier on - at one point her reading was close to 40 (?)  (our normal  is 7).

After Dad passed away, I have kept her medical appointments and established a routine so our helper is able to assist in doing the necessary.  This includes getting a medicine box with day/noon/evening/night slots as well as a list of her medications with instructions on the dosages.  I also made sure she understood the purpose of each type of medicine.

Our helper is really a great help indeed. She also administers the insulin jabs for mum.  I could never bring myself to do it :(

Mum had a fall

Mum had a fall two years ago while going to the toilet.  She had walked and slipped. Luckily she did not fall backwards. Our helper was behind her and took her fall - Mum sat on the floor and fell on her.
She did not feel any pain and went back to bed. At about 3.40am, the helper woke me to let me know that Mum complained of pains in her groin.

I had returned from a late meeting and went straight to bed - so I slept through the fall too. I was afraid it was organic and quickly asked if she had any blood discharge or medical conditions during the day.  The helper then told me about the fall.

I called for the ambulance and got her admitted right away.  At the A & E, doctors did an x-ray and it showed a hair line crack of lumbar one - her back bone. Pains had surfaced in her groin/hip area.  The only thing they could do for her was pain killers until the ward doctors took over.

I consulted my cousin who is an ortho surgeon - he gained access to mum's x rays and told us that she was lucky as ordinarily, a fall like this would have caused many splinters of the bones in her body.  Given her age - her bones have in fact collapsed due to osteoporosis.   I attribute her 'protected' condition to her regular intake of milk - that gave her ample calcium to ward off more serious damage from the fall.

After the fall, mum did complained of backaches - but she recovered quite quickly and well.  We decided to let her wear adult diapers to avoid the risks of her waking up and falling in the middle of the night.  She at first resisted but after our explanation, she relented.

How culture and superstition works on an elderly

Mum is not educated and her behavior is also driven by superstitions and old folks' tales about western medication etc.  After we started chanting and became Buddhists - we began the process of letting her unlearn many of these - for example, not taking medicine during festive occasion like CNY.  Not taking medicine for fear that it is too strong and damaging to her organs.

Her glucose readings now fluctuate between 7.7 to 8.6 now - with her regular insulin jabs and medicines.  She goes for her quarterly polyclinic check-ups and yearly eye check plus kidney & liver panel tests. Everything being equal, she is good.

Beliefs and superstitions play a major role as far as medical care is concerned - particularly for the elderly and unfortunately also passed on to their care of their young too.  The refusal of medication by caregivers for their loved ones has caused much anguish and unnecessary pain to everyone.  This is something that education and hopefully wisdom will prevail.

Family's wish, Doctors' mandate

Our mandate to her doctors whenever she is admitted for any condition is simple - she must not be in any unnecessary pain - or major discomfort. If these are unavoidable, then whatever is allowed medically must be done to alleviate it.

Hallucinations

As she ages, Mum's sense of her surroundings and her timings are not in-tuned.  She has lapses of memory and her lucidity also waxes and wane.  After her recent two bouts of urinary tract infections, she had started to have episodes of wakefulness in the middle of the night (rather early hours of the morning).  Our helper who sleeps with her told us she woke up and asked to go home (Paya Lebar - her childhood home).  At times, she would asked for my Dad and mistook her for Geok.

In the morning, she would be lucid again - and was unable to recollect anything about the night before.  We are monitoring the situation and am prepared to activate night care if this worsens. In the meantime, she is her smiley self during the daytime. 

Her routine, gadgets and all

She still chants twice a day and goes for her garden strolls in the evening.  Her weekday visits to the Foo Hai Elderly Lodge at marine parade still continues.  This is where she has her fellow elderly friends and her exercises.  We explored this some 8 months ago after she became restless at home and have been pleased with this arrangement.  She goes there from 930am till 4.30pm, weekends and public holidays excluded.  This has given me a good 6-hour respite.  Geok plays cards with her every Sunday.  We also give Mum a deck of playing cards to play by herself and occasionally she gets to do that with her elderly friends at Foo Hai. We also bought her a Acer tablet to let her watch her Hokkien drama series (with headset as her hearing is quite hard now).  

Home-doctor care

During her recent hospitalization, the doctor at her ward discussed with us about getting home care - via the Agency For Integrated Care (AIC).  Nurses and doctors (St Andrew's is her assigned hospital - the other available is Home Nursing Foundation) will make periodic visits at home to monitor her chronic conditions such as diabetes and high cholesterol. She would not be required to visit the polyclinic for her check ups and medicine.  These would be done at home.  I think this is a good measure and certainly helps to lighten the load of caregivers.

She receives subsidies based on means testing done some two years ago - so the costs of these are manageable.

Thanks

An Old Friend and New Connections

I once posted a greeting card I received from an ex-colleague, Mdm Goh.  I worked with her during my tenure as the Manager of the SAFRA Clubhouse.  Mdm Goh (Janet) was a receptionist we recruited when the clubhouse renovated and we needed to beef up the staffing at the front desk.

Janet was given a golden handshake after 25 years with MayBank.  She was only 48yo when she joined us at SAFRA.  I found her to be very lively and a keen learner even at her age.  She is married to the same man for 32 years and they never had any children. 

After I left SAFRA in 1991, Janet had been sending me yearly greeting cards.  In those cards, she would write quite lengthily of how she was grateful for the years of working with SAFRA and the opportunity we had given her.  She would often shower my family and me with blessings from God.  She is a devout Christian and knows I am a practicing Buddhist.  It is always very heart warming to receive her cards.

On 19 May 2013, I received an SMS from Janet :-  

"blessings 2 u bernard i just want 2 tell u my husband passed away on O2 may. it was a sudden death he fell down when the ambulance came he was already in coma the doctor told me his brain vessel burst n also a clot in the brain. the doctor says if he comes round he will b a vegetable. bernard i have 2 learn n get used 2 staying alone. everynight before i go 2 bed he wil make a drink 4 me now the drink maker is gone we go out together quite often he told me now that we r retired we have alot of time 2 spent together my constant companion is no more before they close the coffin a final look at him i say my final sayonara 2 him. he is 78 years he is in Heaven."

I immediately returned her call - she was crying and repeated what she said in her SMS.  I was overcame with emotion and held back my tears as I tried to comfort her.  I told her that I would meet her soon to catch up. 

When we caught up, we had a very good chat and caught up at her place near the Soka HQ.  We had a good lunch after that and I took a walk with her near the coffeeshop.  She was in a much better spirit and was her chatty self.  She then told me that she wanted to make a passport as her late husband did not like traveling so her old one had expired.  I offered to help her and we took a walk to the nearby photo studio to have one taken.  Interestingly, the studio also had a copy of the application form from ICA. 

After the visit, I came back and proceeded to mail the form for her. I promised that once ICA informed her that the passport was ready, I would accompany her to pick it up.

It felt good to be able to reconnect with her and do so many practical things for her.  Janet is 73 yo this year.  She is very healthy with no other known medical conditions.  She has a voracious appetite too :p.

Last week, I brought Janet to collect her ready passport.  Before that, we managed to make an appointment for the collection too or else it would have taken her more than 2 hours do so.  We again went to Kallang Leisure Park for lunch.  She told me that with the new passport, she would be traveling with her friends from church and her primary school :p  Her niece would also be bringing her for trips too.  I am very pleased to be of some help and comfort.  I especially also enjoyed her regaling me stories of her childhood and 32 yo marriage to her late hubby.  I am particularly comforted that she has many friends and loved ones who are looking out for her.  

An old friend has started new connections. 

Empathy and How It Works On My Noisy Neighbors

Recently, I encountered a problem with an upstairs neighbor.  You see, over the almost 5 years living here, I never realized how noisy they have been.  Perhaps with my flexible working arrangements, I stay at home a lot more.

There are two parts to the noise issue.  Firstly, I believe they are operating some kind of repair business in their house.  This means quite regular knocking and heavy movement of equipment throughout the day.  Second, perhaps more tolerable and understandable, there are noises from their two young girls.

One day, my nephew was helping his exams when I decided to visit the neighbor to gently ask them to pipe down the first source of noise.  The young man was nervous and came out of the house, presumably to prevent me from getting to near to the gate to see what was going on.  I saw some window grille on the floor and another man peeping out to look at me as I spoke to the first man.

He got defensive and told me that even he had problems with noises from his upstairs neighbors. When I suggested that he might want to inform HDB about it, he told me in a brush, that perhaps that I should do that.  I shook my head and left.

In the 5 years living here, we have been good neighbors.  The patriarch was a friendly man who also engaged in nice banter whenever we met in the void deck.  After he passed away, I had to engage the matriarch twice as there was water seepage from their toilets and kitchen that required repairs by HDB appointed contractors.  Overall, I would rate the relations as cordial. I even explained to one of the sons and asked for his understanding regarding the repair to the ceiling which needed us both to share costs.

So how do I deal with the noises.  I have decided to co-exist with it. I have spoken to the HDB officer in charge of our block - he had kindly offered to visit my neighbor but I told him to let me monitor the situation.  My reasons are quite multifaceted. I do not wish to upset the dynamics of our neighborliness.  The situation compared to those I read online is still manageable since I do not have noises into the unholy hours of the night or early morning.  The main reason is the first source of noise originates from the young father who needs to support his family of two young toddlers.

I know it might sound holier than thou or even exceedingly altruistic.  I really worked this last reason internally.  I see the two young girls going to child care on occasional mornings and have seen the young man going out with his family.  They are not malicious people.  Just our heartland Singaporeans trying to make a living.

Some adjustments on my part however, have to be made to live with this new intrusion.  I use a noise cancelling bluetooth headset to watch the TV.  I also go out more to work or do my errands.  Occasionally, I have had to put on my earplugs that block out both low frequency noises.  Of course I listen to music on my computer if I need to work at home.

Friends have asked why I needed to compromise so much as it involves my home - my private sanctuary.  I explained that it is really what comes with the territory - of communal living.  Would I act on it ? Yes, eventually when the din becomes absolutely intolerable.  For now, I want to take a higher moral ground.  Hearing patter of the kids' feet when they return from child care in the afternoon is a sign of life, isn't it?

It helps that I am into gadgets :p.  The noise cancelling headset is a great help that lets me enjoy movies and music even better.  So is the expensive but highly effective ear plugs that work wonders.

  

Ideas for better aging....and a more gracious society...

Just returned from Katong 112 - the latest and supposedly hippest shopping mall that used to occupy old Katong Roxy mall.   I went there with Mum and our helper for lunch.  The mall is brand new - and many aspects are quite friendly.

Wheelchair-friendly toilets

There are toilets for wheelchair bound shoppers too.  The toilet on Level 4 near to the food court was locked when we wanted to use - and the cleaner had to be located to open it.  It is locked presumably to prevent abuse by other users, though it is really not necessary as the main toilets are ample.

My concern is, what if it is an 'emergency' ;p ?  The lift (there is only one) is quite a distance and the cleaner with the only key to open is not to be found anywhere near?  This is quite operational and unless one is in that situation, it might seemed nitpicking.  Anyway, it is something for mall/building owners to note and improve on.

Usage of elevator

The mall provides a nice travelator that brings those who park to level 1 and thereafter with escalators to all levels.  I notice that practically everyone uses the elevator - and because there is only one, those who need it - like Mum with her wheelchair as well as many elderly who are less mobile, or even parents with strollers end up having to wait even longer for the already slow transporter.

I think mall/building owners might want to consider putting up polite notices to 'remind' shoppers to give way to users who are more in need.  It is also useful to point shoppers to nearby too.  I saw some of the worst behavior just now - able bodied shoppers who squeezed and held back the elevators just to get in -  only to go one level up.  :(  This is something that happens to even our own HDB lifts but then its a different gripe :p

I think the small Ps and Rs have really been forgotten by building owners in their pursuit of huge and often wasteful big PR exercises.

MCYS has a campaign to promote family friendliness and there had been many ministerial level committees to look at making Singapore more elderly friendly.  Are we losing the trees for the forest?

Some ideas for better aging....

Dangers of promoting a Culture of Envy

I spent more than 8 years with a local media company.  I have also witnessed the impact of social media and the good as well as the bad it brings to our society.  Media,  particularly the mass platforms will continue to be a potent influence on the minds as well as the behavior of society. 

It influences opinions and shapes the values that our young will grow up with.

I am concerned about the angle that reports in our mainstream media are taking.  These are becoming very muddled between celebrating success and grovelling the haves of individuals.  Success stories are important to motivate readers/viewers to aim higher in their lives and work towards their goals.  But these stories must surely involve how the successes were achieved - EFFORTS and REWARDS must surely go hand-in-hand !

Yes, there are people who are just plain lucky - or even fortunate to get the help and enjoy the generosity of others - then we must promote the values of help and compassion.  

I have read and now stopped doing so altogether - the money page of Sunday Times that interviews individuals on how they manage their funds.  It almost always concludes with where you live (answer - a condominium or two-storey semi-D etc), what is your best investment (answer - I invested in something and now the value has tripled etc). 

The reports on the Ferrari accident that involved a taxi driver and a motorcyclist again contained information that I feel is really irrelevant and unhelpful to this atmosphere of unhappiness with foreigners.  The driver of the Ferrari was a young China financial consultant who (bought a $820,000 private house in the east), and had just bought the sports car worth $xxx, 000). 

I do not see the relevance of such details to the accident report.  Yes, it sells newspapers but surely there are cheaper (pun intended) platform to report them.  We should be doing the humanistic reporting - how is the injured, how are their families coping, how can the compassionate individuals go about offering help.  Of course, these reports have subsequently been made on the taxi-driver and his young kids. 

Is gutter reporting a way of our lives now?

 

'Maid' to do EVERYTHING...

I was having dinner at a restaurant in the Triple One building on Saturday. It has a full view of Orchard Boulevard Road. I noticed an MPV parked alongside Paterson Road with 2 domestic helpers almost struggling to help an elderly man onto his wheelchair. The driver, a big man of about 1.9m was standing on the side barking orders at the two petite helpers.  Another vehicle with a family was parked behind and from the flurry of activities, I can only deduce that the driver is a family member.  

 My reaction was one of disappointment that a huge effort by two female helpers could have been an act of filial duty that would have also been easily carried out by this able-bodied male family member.  This could have been done as a matter of practical need as the the elderly could have fallen from the car. I think even a concierge or valet of a building would have felt this act of compassion. A separate incident - this time involving a young mother in her early 30s at Parkway Parade.  She was with her three kids.

Except for the toddler carried by her helper, the other two are quite big waking on their own. The helper was walking behind with both the toddler in arm and a big bag. She kept having to adjust as the total weight must have been a real strain on her small frame.  Certainly the Ma'am could have 'helped' the helper instead of risking her tripped over with her kid?   To be fair, I do not pretend to know the dynamics of these families.

However, I think the behavior of the employers touch on human decency or rather, lack of.   I agree that we need to seriously look at how we treat our domestic helpers - and this must go beyond not calling them maids - I am more concerned that we have become a society that is over-reliant on them for even the most basic of chores.

The longer term implication of this mentality is what this signals to our young and how they will treat others in turn.