Monday, May 10, 2010


I am down with URTI again (upper respiratory track infection).

My ward had H1N1 and H3N2 flu cases for the past week. I wore a surgical mask at work most of the time for the past 2 weeks. Mainly out of fear of sneezing, coughing or dripping fluids from my running nose in front of the patients and spreading my pathogens to them. Afterall, the surgical mask does not provide adequate protection to the wearer from airborne pathogens. No one in my ward wears the N95 mask since the H1N1 flu was downgraded in severity. The only exception that I have seen recently was a respiratory specialist consultant while attending to her adult patient at my ward. [Note: Doctor JY also happened to be my attending consultant for my pneumonia episode.]

Back to my symptoms. Had been having running and congested nose on-and-off for the pass 2 weeks. Appetite is less, but still Fair. However, from Thursday onwards, the symptoms took a turn for the worse. I had an acute sharp pain at my chest where I had a history of minor atelectasis. Onset of cough which became more chesty over the days. Mucus and phelgm turned yellowish and of mucoid consistency which is worse in the morning. [Note: Not uncommon, given my history of asthma.] Thankfully, SpO2 is within normal range. Significant drop in appetite. I only manage to take 1/2 share of 1 main meal each day. Thus, I supplement my intake with snacks, juices, electrolyte drinks and nutritional supplements.

Finally, this morning, my sleep was interrupted at 3+am due to nasal congestion and a painful, itchy and scratchy swollen larynx (i.e. sore throat). The throat was so bad that I could barely take some fluids for breakfast. I couldn't get back to sleep, so I did my laundry and other chores instead. Then around 7am, my tired out body finally rested for 3 hours. I woke up to run some errands before I went to my hospital's A&E.
My hospital's HR is more willing to accept MCs (medical certificate for excuse from duty) from its Medical Officers. Up to 3 days of MCs from GPs (general practitioners) are accepted by HR. Thereafter staff are required to consult with the hospital's A&E MOs for an extension of MC.

Although the A&E was not particularly crowded (maybe around 20 patients), the combination of my low-severity and my arrival at 1+pm led to a long waiting time. According to the agency nurse at triage, the A&E staff held-up the cases from 1pm onwards until the agency nurse started her shift at 2pm. Thus, my hospital visit took 3+hours. I requested for Doctor Y, one of the Medical Officers on-duty, since he is somewhat familiar with my medical history. [Note: He happened to be the attending MO when I had pneumonia, and was also my pre-Employment check-up doctor.] Besides auscultation and the visual throat assessment, his check with the otoscope reviewed that my ears are also partially blocked by mucus. He asked how many days of MC I needed. Ha ha, typical of the service-oriented doctors in the private sector! Anyway, I requested for 1 day of rest for tomorrow, since it's my day-off today. If needs be, I could always return to the A&E for a review.
My ward manager had mentioned previously that, due to an increase in staff MCs for respiratory infections during the past months, the DON had requested the admin staff of every ward to report all respiratory MCs directly to her. Guess I'm on the list now! The increase in respiratory cases amongst staff does not surprise me given that ADON G discouraged staff to wear masks at work, other than for Isolation cases. She claims that the it muffles the enunciation and blocks-off the lower facial visual communication. Now her direct report, the DON, has to personally track staff's respiratory MCs. What a farce!

I wore an N95 mask from my entry into the A&E until I returned home. I was offered a surgical mask at the A&E entrance, but I wore my own N95 saved from a previous training session instead.
Yes, I know that the N95 and other masks are supposed to be single-use only. But to save costs for the hospital, the Infection Control Officer instructed us to save the "clean" N95 masks for a future use.

On my way home, few people noticed that I was wearing a mask. And even if they did, they turned their gaze away quickly. Most are absorbed in their own worlds. I wondered what makes Singaporeans, myself included, reluctant to wear masks in public whenever they have coughs/colds? A lack of awareness on the purpose and usage of a mask perhaps?
E.g. While I was at the A&E Isolation Room, a family -- consisting of grandma, mom, daughter and son -- arrived after me. They were there because the boy was coughing for a week without improvement after several visits to their GP (general practitioner). Initially all 4 of them wore surgical masks. When I informed the grandma that she was wearing the surgical mask upside-down, she cheerily disregarded the information saying that she's not the one who is sick. Subsequently, while waiting to collect the medication in the general A&E area, all of them took off their surgical masks. The grandma even chased her coughing grandson out of the Isolation Room to join his sister and mother in the general A&E area. Sigh! Infection control failed.


  1. poor doll take care there!
    your posting's no surprise at all....recycling N95 mask is like recycling used tissue paper...this kind of measures will make mode of transmission worst. imagine the mask full of your secretions post use?? I wouldn't save any stuffs for the hospitals so that the fat cats up the top can get their dividends and bonuses. I will throw what l think is contaminated and l expect my staff working under me as well.

    anyway, rest well. chat again soon!

  2. Hi Bone Collector,

    Thanks for dropping by. Used tissue paper, ha ha! Apt analogy indeed.

    Will be back to work later today. Still phlegmy but at least able to resume normal diet now that the throat is not so swollen.

    You got the expensive Tamiflu from your GP? Lucky you, medical is FOC for you after your insurance and tax payments, ya?

    My medical is FOC if I go to my hospital's A&E. If I go to a GP, in addition to the limit of maximum 3 days MC, I have to go through the hassle of claiming medical expenses (limited to SGD20). The MO gave me anti-histamines (diphenhydramine, cetirizine in Zyrtec-D), decongestant (pseudoephedrine in Zyrtec-D), mucolytic (Fluimucil), pain relief for sore throat (codeine in Codipront) and antibiotic Augmentin. Glad I took MC for yesterday. The medications knock me out, especially the diphenhydramine and codeine.

  3. Hello!

    I was also a former student from the accelerated nursing course. I used to work in the media industry and made a career change because I wanted to migrate.

    I'm now in NZ and life has never been better. No regrets whatsoever, and I'm sure when you've settled in Canada you'll be wondering why you didn't take the plunge earlier!

  4. Hello CK,

    Thanks for dropping by and leaving a note. So you're my "senior" in the accelerated nursing course.

    My class has an ex-media industry student too. I heard that she is an Australian PR, but came back to pick up nursing in Singapore, with the intention to return to Aussie as a nurse someday.

    NZ was my 2nd choice after Canada. How's life there? Are you still in nursing, or back to media, or moved on to another line?

    As I mentioned to estlxlan, another accelerated nursing senior, in an earlier blog-entry's comments, I was still in my previous career when I decided to migrate. My IT experience would probably qualify me for migration. But then, I thought, "why not pick up another skill to improve my adaptability while waiting for the PR to be approved?"


    Actually, I landed up in nursing quite by chance. I was deciding between early childhood (pre-school) education vs nursing. Then, an old friend called up to inform me that she spotted a nursing career conversion talk in the newspapers (i.e. she knows that I didn't read the mainstream newspapers). So I went for the talk and one thing led to another. Viola, I'm here ranting away.

  5. Hope you get well soon. Always so worried about you when you get sick as you have so little reserves. Unlike us meat eaters, you are not getting that constant flow of low level medication from eating intensely farmed livestock! :-)

    Tamiflu appears to be rather a con, and can actually make things worse.

    My poor son took it during the height of the outbreak. Taken orally. Main side effect? Immediate vomiting. Defeats the purpose.

  6. Hi ya,

    Yes, I was from one of the first few batches of the accelerated course.

    My first choice was actually Australia, since I did my undergraduate studies there in my early 20s. I then spent the next decade trying very hard to migrate, but 9/11 and SARS put paid to my dreams.

    When the course came up, it was like a godsent. Probably the only good thing PAP has done, in my opinion. ;) I quit my job and enrolled in the course, where 99% of my coursemates were retrenchees and looked at me as if I was mental for quitting a job and joining nursing. But as far as I was concerned it was a ticket to get out.

    I have had the same old crap like what you are experiencing now, but I knew it wouldn't be long before I am free. I had to pay off a 10k bond, but I treated that as the school fees.

    By some serendipity I ended up in NZ, which although economically weaker than Australia, is friendlier and possibly even more laid back than Oz. The weather is better too, and better to me = cooler, not like the crazy 40 degree temperatures in Melbourne during recent summers.

    I'm still in nursing, in another discipline that is related to what I did. I do Mondays to Fridays, office hours, with the odd oncall duty if I want to earn more. Nurses have lots of autonomy here and our voices are mostly heard. I enjoy my work, and patients are interested in their health, rather than asking you to tell everything to their family or maid.

    I've been here for over a year now, and life is great. The air is fresh and I get lots of space. I get paid more here too, about 3 times more AFTER tax.

    I believe if you're the type of person who is not interested in food or shopping, then moving to another country will make you happier.

    Because over here, I'm treated with respect.

  7. Hi Tim,

    Ha, the "constant flow of low level medication from eating intensely farmed livestock"! Well, I get the vegetarian's equivalent, I guess... the constant flow of low level pesticides, ha ha. Too bad going all organic is beyond my budget at the moment. Anyway, I find myself craving and eating "feel good" foods recently when I'm stressed. "Feel good" = high fat + high sugar, e.g. Chicago cheesecake. So I may be getting some of the indirect antibiotics from the cheese/milk. ;-)

    Hi CK,

    I would agree about "the only good thing PAP has done", although I will have to count my interest-free university loan from the Public Service Commission during the late-80's/early-90's too.

    "coursemates were retrenchees and looked at me as if I was mental for quitting a job and joining nursing"

    Things changed somewhat during my time. My course started after the previous 2006 election, where the ministerial pay went worldwide record breaking stratospheric, GST was increased to "help the poor" (poor ministers?) and "no means testing" became "means testing for fairer subsidies". Some in my class have plans to exit, just that they are hush-hushed about it. One of my classmate has already landed in Canada. I will be the next to go, then another classmate will follow.

    Like you, I will have to pay up the outstanding bond (around 30K), and am treating it as nursing school fees. Based on my research, nurses are better paid AFTER tax in Canada too. IMHO, it all boils down to the PAP economic system of squeezing the max from its workforce. Thus, my hopes are short-term loss of 30K in exchange for long-term gains of social security and better work-life balance.

    Keeping my fingers crossed as to my adaptability. Nevertheless, I think it'll be an interesting experience.

  8. I guess the price of breaking the bond went up because of us bond breakers, oops!

    Unfortunately many of my coursemates didn't know what they were in for when they signed up for nursing. One drastic example was this chick who didn't know that she had to clean bums and stuff. Duh?

    They all took it up because there was a job guaranteed at the end of the course. Unfortunately again they didn't know they'll be paid so badly in comparison to what they had to do, and the things they have to put up with. So more than 90% of my coursemates have left nursing now that the 3 years are up, with more than 50% breaking the bond.

    As far as I was concerned, you take up nursing on the island ONLY because you want to migrate.

    $30k is a good amount of money, but your attitude is the right one. You do get social security and great work-life balance once you leave the island. At least in NZ I do. Work and life is really balanced.

    Just make sure you hang out with the locals once you moved, and not with them Asians, otherwise what's the point. And also lather yourself with LOTS of moisturizer during the cold and dry months.

    Those are the only 2 advice I have for you really. :)

    Enjoy! Freedom is near. :)