No! No! No!

We had a 2 year-old boy with a Caucasian daddy and Chinese mommy admitted for Influenza A, and thus required to be isolated. As anyone who has handled active toddlers will know, it's hard to keep an active toddler happily entertained in a small room for days.

It's day 4. The boy was crying to go to the playroom this morning. Daddy called for the nurse to enquire if the boy could spend some time there since he was to be discharged for further management at home. Unfortunately, the boy was still not cleared to be de-isolated. Then, daddy tried to trick boy into drinking his milk (given his reduced intake for the past days) by making it a pre-condition to playing outside.

Daddy, "Do you want to drink your milk? You can go out to play only after you drink your milk."

Boy, "No!"

Nurse (me), "How about Ribena?"

Boy, "No!"

"Water?", "No!", "Milk?", "No!", "Apple juice?", "No!", "Orange juice?", "No!". And on it goes with the "terrible twos". Fortunately, daddy has patience and a sense of humour.

Finally, I teased, "How about some beer?"

Boy, "No!"

Daddy chimed in, "Champagne?"

Boy, "No!"

Daddy remarked with mock surprise, "You don't want some champagne? What a pity!"

We both laughed.

Blind outsourcing = a race to the bottom

Reading Lucky Tan's post, especially the comments, reminded me of the state of my previous industry in Singapore.
http://singaporemind.blogspot.com/2010/07/12b-still-get-monkeys.htm

Blind outsourcing = a race to the bottom + managers' (i.e. decision makers) unwillingness to take personal responsibility and risks

Unfortunately, the kia-su 怕输 + kia-si 惊死 culture is pervasive in Singapore. IMHO, it is also apparent in the entrenched dominant political party. See spoofs of its PR failures here, here and here. That is why I do not hold high hopes for the future of Singapore.

Of course, as Anonymous at 16/7/10 22:59 commented on Lucky Tan's blog, it does not have to be that way. At least not at the company level, e.g. in the decisions made by HQs based outside of Singapore. Or at the immediate supervisor levels, e.g. I've had bosses who held their stand well [but none were Singaporeans and all have left Singapore].

Ghosted in translation

SN L and SEN MY are both from the same nation, one which borders China. SEN MY is half-Chinese and grew up near at a border village which frequently trades with travelling Chinese merchants. Thus, she speaks fluent Chinese. SN L, on the other hand, understands only a few Chinese words and has an English-speaking Indian grandfather.

One day, a patient's grandmother was speaking to SN L in Chinese. She probably thought that SN L understands Chinese based on her nationality. SN L only caught the keywords, “有很多．．．？” and “小孩” ["Are there many?" and "children"].

Thinking that the grandma was asking about the patient census, SN L replied, “很多，很多。” ["Yes, there are many."]

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The next day (day 3 of admission for the patient), the patient was for discharge. Of course, most parents are eager to bring their children home. In this case, the patient's father chased the staff several times for discharge immediately after the doctor has reviewed and approved it (while the doctor was still reviewing other patients). I thought that he was extraordinarily eager to get his pre-schooler out of the hospital.

Towards the end of the shift, SEN MY gave me the answer to my puzzle. She was tickled and eager to share her joke. It was due to what patient's grandmother told SEN MY earlier that morning.

On the 1st night of admission, the patient was fretful and refused to sleep. The next day (day 2 of admission), the patient told the grandmother about seeing "someone" under her bed, which was near the door. Thus, the parents insisted on changing to the bed nearer the window (in the 2-bedded room) when the neighbouring patient was discharged that morning. The grandmother asked SN L in Chinese if there are many ghosts in the ward and if any of the children were frightened. “這里有很多鬼嗎？小孩害怕嗎？“

As mentioned above, the meaning was lost-in-translation and thus the ward became (haunted) "ghosted"-in-translation. The patient's grandmother then expressed her concern over the ghosts to SEN MY on day 3 of admission, the morning of discharge. SEN MY had to explain that the ward is not ghosted, but the grandma remained sceptical. Thus, I think that explains the patient's father's eagerness to be discharged.

Fast play, slow motion

Have not been posting for awhile. In fact, have not been reading my regular diet of favourite blogs. Not sure what it is, but just felt like switching to printed reading materials for a while and giving my body extra rest-time where possible.

Wanted to write about lots of stuff, but somehow just didn't get through the inertia to do it. A fast-play of some stuff that I wanted to write about...

• My niece born in May-2010 and her very interesting name. According to my sister (her mommy), it's an original derivation of a famous mathematician's surname.
• The boy who first presented to me crying in pain with guarded abdomen muscles. A drama king who role-played an exaggerated sensitivity to IV antibiotics, but then grinned widely when I praised him on his dramatic skills. His over-the-top, big farewell wave and loud "bye bye" upon discharge.
• The cheerful adult female patient with cats named LKY and LHL. Her humour was like sunshine along the now-windowless ward corridor.
• How we laughed about SSN Y's 7 months of actual workdays a year. Due to a combination of her annual leave quota (from her decades of long service), a weekly double-shift arrangement to get 2 days-off per week, and the 10 days of public holidays per year. She finally got over her aviatophobia (acquired from the days when airplanes rattled while in-flight). Now she is jet-setting with a vengeance.
• The friendly doctor with a cool pony tail. The first doctor in Singapore that I have met who actually break from the conventional Singaporean male's short-hair cut.
• We suddenly have 3 new staff in July. A freshly graduated EN A, an SN LZJ with 1 year's experience at a doctor's clinic, and an ex-staff SSN S who re-joined. I had previously blogged about SSN S here. As the ward census are lower this fortnight than usual, this batch of new-comers are luckier than the previous new-comer SN S who joined during our overloaded period. Headcount-wise, we have SN S replacing SN O's headcount, SN LZJ who replaces mine, and EN A who replaces SEN L's. SSN S seems to be an extra headcount, but then other SSNs have already gossiped about their intentions to leave and the NO is also planning for her succession. Well, for now, the understaffing situation [click here and here] is temporary resolved.

On the other hand, things on the immigration front are on slow-motion to me. Still awaiting for assessment results from CRNBC. Meanwhile, even setting-up a Canadian bank account is in slow-motion compared to the Singaporean pace. Better get used to it! :-P

Controlling behaviour

In response to StorytellERdoc's blog entry titled "Who am I treating?".

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We get such controlling behaviour rather regularly in Singapore. Unfortunately, management and the work culture (it's a private hospital) tends to bow down to patients/NOKs who raise hell, so it becomes a recurring pattern on their future admissions.

I am in the Paediatrics, so parents have an "excuse" to provide information regardless of the child's age. Some parents seem to think that their treatment demands should be met, although our professional assessment of patient may indicate otherwise. It can be an annoying situation. [Edit: Come to think of it, even the consultant doctors face such demands. Although they face it less frequently than the nurses, IMHO, due to parents having more respect for a doctor's assessment.] Then again, IMHO such controlling behaviour often extends beyond just treatment demands (e.g. demand to jump queue for private room).

E.g. Recently there is a case that should rightfully belong to High Dependency Unit (HDU) but is nursed at acute ward levels. Ostensibly it was for the hospital's compassionate image in catering to the parents' budget issue. However, it results in overloading the ward nurses with HDU work in a busy acute ward short on trained staff.

The child was admitted because of infection from a previous ventricular shunt inserted at an overseas hospital. The mother was obsessed with the patient's temperature, because she wanted to keep the child afebrile to have a ventricular shunt inserted sooner and to prevent seizure. The child was still suffering from on-and-off low grade fever, and we followed our nursing protocols.

One day the temperature spiked from afebrile to 38.2 degC (100.8 degF) in-between an hourly temperature monitoring. The patient's mother was verbally nagging and blaming the nursing staff non-stop (especially me since I was in-charge of his medications that shift) for not monitoring him more frequently (on-demand) and not giving him the anti-pyretic while he was afebrile. She was demanding that I give paracetamol STAT via NGT, while I was preparing the patient's STAT IV Albumin drip order at his bedside. [Edit: I told the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment. Nevertheless, she went on threatening and complaining of poor nursing care.] I finally told her, "I am handling a very important treatment for your child, please can you give me a few moments of peace to ensure that this goes correctly?"

The mother screamed "You cannot talk to me like this!" and repeated her broken record of why because of our treatment that her son is now having "high" fever. [Note: her son came in due to an infected shunt inserted overseas and had been febrile on-and-off since admission.]

The mother never paused for a moment to let me focus on her son's more important STAT Albumin treatment. I hit my tolerance limit. [Edit: I reiterated to the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment.] I told her firmly that we have our protocols for managing a patient's fever, especially in preparation for operation, we don't want to mask any underlying infection and we were handling her child as per protocol. She disregarded my explanation and still raised her voice and continued to blame us. Finally, I told her that if she is not happy she could lodge a complaint. That I was there to help her child get well, if it were for her, I won't care either way. I continued with my work while her husband spoke to her in their language (presumably telling her to tone down), and then she continue running her broken record at a lower volume.

When the patient's consultant PHK came, we informed him of the incident details after he reviewed the patient. Fortunately for me, this consultant was fair to nurses. He returned to the patient's bed and told the mother that we the nursing staff are competent in our work and had been doing her family a huge favour in cost savings by treating her child at the ward. She had been privileged to received such good nursing care at lower cost (and free doctor's consultations). However if she insists on demanding interventions her way, he will re-assign the patient to HDU and she will have to foot the full bill.

That lecture bought us some peace for a while. I was glad the consultant was the one who dealt with the parents. Sadly, I am not confident that my hospital management would have been so supportive of its nursing staff.