Gammaguard face

Last week we had a Guillian Barre Syndrome case which required IV immunoglobulin (IgG). SN L was in-charge that afternoon, with me and SN RB taking teams. SN L is relatively new as the in-charge, and both SN RB and myself are less than 1 year old at the ward. Unfortunately, ICU was full due to several Code Blue cases, thus we had to nurse this case in at the ward instead of ICU. SN L put up the telemetry for ICU auto-monitoring. An ICU nurse, SN R, came to assist with the 1st 5-10min of IV IgG. The 9 year old patient was under the care of my team, so I spent the 1st 15min monitoring her by the bedside, and thereafter close monitoring following ICU's usual practice. When her 2nd dose of IV IgG was due, I was again there to start it.

Today we have a Kawasaki case which also required IV immunoglobulin (IgG). The ward manager was in-charge this morning, followed by SSN R [as in-charge] this afternoon. Both I and my runner senior HCA M were on double shift, taking the team caring for the Kawasaki patient. This child is autistic and his mother felt that he could not be acclimatised to the ICU environment. Thus, treating him in the ICU would entail heavy sedatives or restrains. In the end, the decision was made to nurse him in the ward instead of ICU. This time round, it is a bigger risk. The child's mother insisted that the child would pull-off any telemetry device and any attempts to take his BP would agitate him beyond control. Even setting the IV plug and keeping it on him for the duration of IV IgG would be a challenge. Thus it was back to old-fashioned nursing, with visual assessment of his alertness, responses, respiration rate and the occasional pulse rate assessment. Thankfully everything went smoothly.

Our colloquial term for IgG is Gammaguard. At the end of the shift, SSN R joked that both of us have the "Gammaguard face". I surely seem to have double the luck, for I was there to start both the initial IV IgG.

Two tales of a city

I just read two tales of SIN city today. One from the mainstream media, and the other from the alternative media.

http://sg.news.yahoo.com/cna/20100117/tap-319-singaporeans-come-law-minister-231650b.html

http://theonlinecitizen.com/2010/01/raiding-the-homeless-in-the-middle-of-the-night/

Which is make-belief? Which is reality? For those overseas, a tour of our beaches and housing estates late at night would be an eye-opener of what a "first world country" Singapore is.

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[Addendum 16-Feb-2010]

The Economist: Welfare in Singapore The Stingy Nanny

or click here for direct link to The Economist article.

[Addendum 25-Feb-2010]

For their "wonderful performance" in 2010, the "Ministers got early ang-pow".

1 calamity away from poverty

I had been thinking about writing this entry since the beginning of the year, but kept putting it off because I felt it was possibly my bias outlook. Finally I got around to this after reading Lucky Singaporean's blog entry on Sickness in Wealth and Poverty.

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Singapore does not have universal healthcare. Its ruling political party PAP has given many reasons and excuses for not providing it. In fact, it installed "Means Testing" since the last general election. The rationale given was to prevent the rich from abusing the "public (a.k.a. restructured)" healthcare system by making use of its subsidised wards.

In such an environment, one reads about a respectable 52 year old neuroscientist doctor who needs to raise funds for his own leukemia treatment. Despite his background as a well-known charity fundraiser and years of working as a doctor, Dr William Tan cannot afford medical treatment from the very public healthcare system that he works for.

There are also others who fall through the cracks. For example, the repeated admissions of a 2+ years old patient. This child had operations as an infant due to mal-rotation. Last June, he was admitted and operated twice for ?intussusception. 6 months later in December, he was admitted and operated again for abdomen pain and ?adhesion. By then, the insurance company declared his case as congenital and refused further payment. A week later, the child was re-admitted for abdominal pain and ?obstruction. This time his parents opted to prolong the NBM (Nil By Mouth) observation period as they could not afford another operation. They were a professional couple, born-and-bred Singapore citizens, yet the father told me that going to a public hospital would cost almost the same. Thus they decided to return to my hospital despite their limited budget. Thankfully, after 1 week of nursing care the problem resolved itself and the child was discharged.

Perhaps my nursing kakis are right that Singapore takes care of its destitute poor. [Or does it, really?] However, as the above examples show, the average person is only one calamity away from poverty.

As my friend LC (who was born in Hong Kong, grew up in Hong Kong and Ireland, and worked in Ireland, UK and Singapore) puts it so succinctly in his email to me, coincidently on April's Fools Day in 2009...

"I am afraid, i do agreed with you on Singapore and it is a wonderful place if you don't have to be here forever and you're rich.

However, if you are a nobody, you're at a huge disadvantage compared to other nobody in other countries..."

"Why should it be so?" is my question as a "nobody" Singapore citizen. It seems that the answer, for me, lies in migrating to where Universal Healthcare is available.

Winds and clouds 风云

I was clearing my old emails. Some emails since year 2005 that made think of the chinese phrase “天有不測風雲，人有旦夕禍福。” ["The skies have unpredictable storms, humans have sudden changes in fortune."]

Financial markets

Back in 2005 credit default swaps was the next big thing in the financial markets. In 2005Q3, recruiters were out in full force looking for any person who had related experience. With around 10 years of IT experience in banking and financial services, it was a time of interview offers for me. The supply just couldn't feed the demand as almost every company out there was jumping into the bandwagon. Unfortunately, that included my company's GLC client. It was an eye-opening experience of what "financial talent/expert" could mean and what outsourcing entails.

Fast forward 3 years later to 2008Q3, the first innocuous signs of problems appeared on the USA subprime housing markets. Of course, we the plebeian citizens of Singapore first heard of Singapore's massive losses online. [Click here and here.]

London trip

I went to London in 2005Q3 with 2 purposes on mind. Firstly, to salvage a romantic relationship that had been badly worn down after 1+ year of long overtime and burnt weekends [without overtime pay, just a token bonus of several hundred dollars each year, see below]. Secondly, to consider relocating to London for composite reasons of joining my sibling who was based there, more interesting job opportunities, and closer to my romantic interest then.

I left London heartbroken. Unwilling to give up totally on the romantic relationship at that time, my hopes for recovering the relationship roller-coastered up-and-down for several years more. Workwise, London seemed interesting, but the more urgent issue was to reclaim my life from my job at that time. I decided to leave the company after I had settled my home purchase and renovations. Coincidentally that happened, although not in the way that I had intended (see below).

Ugly Singaporean bosses

At my last IT job, I had 3 inexperienced Singaporean (i.e. citizens) managers in a span of less than 2 years.

The first called in sick 2 or more days in a week and delegated her work to me (on-top of my own role) but reported to management that she had done her work. After much complaints from the client about the MIA (missing-in-action) manager, the 2nd manager was installed.

The 2nd manager was the worst of the lot. From incompetence to blatant racism. Under her, staff were made a scapegoat for her incompetence, one was redeployed to other client sites and another was fired (aside from those fortunate enough to job-hop before they were hit). On top of that, she expected and demanded that her staff arrive at 8:30am and not leave work until after 11pm (way past the 6pm official knock-off time, and would disapprove most of the taxi claims). She does not lead by example, arriving late for work, going missing during office hours, and leaving work early, all with "valid" excuses. Instead she would call the worksite from her home/mobile demanding that her staff are productively at work at 8:30am and around 9 to 11pm. [Note: She would call the department's landline phone and demand to speak to each staff at a time, while she was elsewhere.] Example of her blatant racism: One morning after an India Indian colleague called in sick due to chest pains, this self-declared "good Christian" boss cursed upon hanging up the phone, "Best if he has a heart attack and then don't need to come to work forever!" because as she had previously expressed, she felt that the Indians are a bunch of NATO (No Action Talk Only) backstabbers and sly credit/limelight thieves. After months of inaction from upper management despite the client's complaints, the client gave an ultimatum of firing the entire team if that manager was not changed by x timeframe. The 3rd manager was quickly installed. By then, the team was burnt out after 1 year with the 2nd manager.

The 3rd manager was competent but spent her time backstabbing about each colleague to the other colleagues. She didn't realize that after what we had gone through, the staff were united enough to share with each other about her backstabbing antics. The highlight of her and her boss (also a Singapore citizen) antics was their attempt to fire me for AWOL (absence without leave) 3 days after they had personally confiscated all my access to the work-site. Human Resources, which was based at another location, was not aware of their underhanded tactics until I called them. After negotiations with HR, I agreed to submit my resignation with wordings as per the company's request in exchange for a goodwill compensation of 1 month's pay and accrued leave not taken. The HR manager was coincidentally on-leave on the "exchange resignation-letter for payout" day, leaving her staff to handle the wrap-up.

When I left, I was seriously burnt out and angry. Angry with the ugliness of my fellow Singapore citizens (compared to my "foreign talent" colleagues), the inhumane treatment, my inability to stand up for myself, and my life choices that caused me to suffer the plight. In addition, I seriously questioned the minimal employees' protection in Singapore (unfair employment practices were increasingly common) and the typical Singaporean values and lifestyle.

The present and the future

Fast foward to year 2010. It's amazing how time heals, all the stuff that hurt pretty bad at that time, now seems like a distant memory and amusing at times too. I believe that these past events are a learning experience for me, to guide me in making choices for my long-term benefit and happiness.

I am now more relaxed about life. My nursing training and exposure has played a big part in this change process. As my nursing teachers joked, "Is anyone dead? If not, is anyone dying? If not, what's the panic [for]?"

Just do what you can

Have been pretty quiet and lazy on the electronic communications front since returning from my trip. Finally got around to sending out my year-end greetings today. Thank goodness for the internet's fast delivery times ;-)

Been busy with the usual post trip unpacking, home cleaning and gifts sorting. At JC's ROM reception, we missed TSC's presence for he is the sensibility counterbalance to MC's and my sense. LK looked under the weather. MC explained that LK is still adjusting to her self-employed life without external time regulations.

Thereafter it was back to work, with some busy days, some not-so-busy days and a Christmas party to lighten up the mood. Still it was some adjustment after my rest-and-relax break of a week.

Recently I met my nursing buddy CL while on the bus to work. Her ward was closed and the ward's staff deployed to the other maternity wards during this period. Her ward manager is a kind leader and the staff had a strong affinity to their own ward. Each maternity ward has a different organization of its supplies (even though its the same specialization), which required adjustment on the part of the temporary deployed staff. Thus, CL said that her colleagues did not like to be deployed to the other wards. Anyway, to cheer her up I told her of my new attitude to manage work stress, "Just do what you can."

On the morning of 19-Dec-2009, SEN L was my runner. Seeing that she was somewhat down at this festive season, I invited her to join me for a Chinese movie since I had a pair of free tickets from my credit card points. After the movie, we continued with shopping and a long chat [Edit: Yay, fruitful shopping! I spent about SG$100 on several items that I really love and L spent about $70+ in the sales]. I have always felt that L was too astute to be just an EN. Turns out that she was lured to be trained overseas in Singapore as a nurse, just before she was about to attempt China's university entrance examinations. To cut the long story short [click here, here and here], she is likely to be stuck as an EN if she stays in Singapore. She shared that she has siblings in Japan and Canada [IMHO, real first world countries], but she has not decided if she would join either of them. From her past sharing, she seemed keener on Japan than Canada. Since I have a collection of Japanese textbooks and dictionaries mostly lying idle [Edit: From 15-20 years ago when I learnt Japanese], I will be giving them to her. May it spur her to do something for her own future.

As for me, I have been tasked by my ward manager on several items, mostly to assist with documentation of procedures [Edit: For the forever impending JCI, ha ha!] and managing the treatment room. From my personal interests, I would like to share some IT skills with my colleagues while I am still around. Especially with the older or foreign-trained staff who did not have the benefit of IT exposure. That is the culture I inherited from my IT background, "One always try to pass on one's skills before leaving". I also plan to suggest some changes to the billing system so as to facilitate our nursing billings and to minimize the items used but were not billed.

On a personal front, I would like to meditate more consistently, as it helps to smoothen out my workday. In addition, I am planning to re-learn French again since Canada is officially bilingual. Meanwhile, I'm still awaiting for the approval from CRNBC to attempt the CRNE (Canadian Registered Nurses Examinations). Once that goes ahead, I will have a full plate studying for the examinations. If I have any time leftover, I would like to squeeze in some Yoga exercises... which I have neglected for years!

Looks like a busy and fruitful year ahead! May you have a good time too! For those interested in Chinese astrology, here's your forecast for the coming year of the Golden (Metal) Tiger.