Nine Doctors, One Cup

23rd April 2017

Doctor One is not amused. Neither am I. This is A&E Singapore General Hospital, the largest but also oldest in this technocratic utopia. You’d think they’d have someone replan the space by now so doctors don’t have to brisk walk around different blocks of clinic, triage, waiting room, random wall, calling out for loved ones who are also walking in a daze around clinic, triage, waiting room, random wall and security, to ask after two hours or more what has happened to their sick.

When we are reunited, they tell me he’s been okay for awhile now without apology. But with all the other admitted burping, farting, waiting to be wheeled out into the wards, they have not had time to clean the blood caked on his forehead. I feel justified and purpose-filled, slipping open their drawers of medical supplies, secretly pleased that I get to play nurse now with him. We’re not together yet. We haven’t discussed it. But I told the reception anyway without pause, he’s my boyfriend. He’s had a seizure. Hurry (the fuck) up.

Doctor One asks if we’re Singaporeans because this will affect the class of ward and fees he has to pay. Doctor One doesn’t expect either of us, least of all me to pipe, I am. But he’s not. And when they wheel him down the corridor, I walk with them and feel curiously tender. Spousal.

He is given a ward more corridor than room, with four bed-mates. No doors. One of them has a sign above his head and two bored policemen playing games on their mobile phones, gun and baton slack on their belts. I whisper to him, I saw that guy come in earlier. He opened a car door and collapsed, the triage staff rushing out to collect off the driveway. The policewoman who escorted him here, was also on her phone. Probably texting her boyfriend. It’s another shitty hospital call. Routine. But shitty.

For this ward, which still we should be grateful for (people are dying in Africa after all), my foreign lover will have to pay probably three times as much as what I would. But I’d get room in a ward with a door. Or at least some semblance of an entrance. At least there are curtains. At least, because my lover is a white male, no one in this room will be unfairly treated.

 

26th April 2017

Doctor Two is not my first choice. My regular GP two doors down is out to lunch and the swelling in my throat is unbearable. What difference might there be anyway? This is a middle-class neighbourhood.

I’d woke up in the night crying. Unable to swallow. My lymph nodes look like ping pong balls sticking out of my neck. Doctor Two confirms swelling but decides: No antibiotics. Just fancy panadol and another pain killer. I accept the diagnosis like water after drought. Like a weak man, only threatened with the torture, and giving up.

 

27th April 2017

I am so weak, my parents have to take charge. My regular GP, they say, but he’s not in. So my regular clinic, my semi-regular GP. Doctor Three is a firm and professional sort. But the weather conspires against him.

It has been heat and thunderstorm, heat and thunderstorm for awhile now. I’ve heard that the government is aware the increasing fluctuations and increases in temperature here are definitely having an effect on the elderly, children and those with sensitive constitutions. About a month from now, President Trump of the US will pull out of the Paris Accord. Motherfucker doesn’t think climate change is real. Maybe that’s why he pulled out of APTA too, so he could pretend half the world doesn’t exist.

We have four brief power outages in the course of just my examination because of the thunderstorm. Every time the clinic darkens and Doctor Three rushes out to check the power box with the reception, I think of a zombie apocalypse Singapore style. The merlions with their decaying jaws flopping out of our drain pipes, curiously proficient at covering ground despite their tails-for-legs. I think Doctor Three, who has just left the room again with a smile saying Sorry! to check if the whole block is affected, will not come back. I am ready to grab some needles from the supplies to stab myself. I’ve already decided, in case of zombie merlions, I don’t want to be a hero.

 

3rd May 2017

After a course of antibiotics that seems to work, I wake up again in the night, more swollen than ever. I have never experienced this much pain in my life. It is 4 am. Between hospital and 24-hour clinic, we pick clinic thinking the wait time will be less.

My father and I uber to the closest one in Serangoon North. Doctor Four is a young man in a Barney purple hoodie. Maybe younger than me. Clearly decided he wanted to be a doctor after watching Dr. Turk on Scrubs. He says he’s sorry I’m to be given more pills, a second round of antibiotics on the heels of this first course I’m finishing, that will “hurt like a bitch” when swallowing. Huh. Cool bro.

He also gives me steroids, although even he has doubts. How bad could that be?

 

— May 2017

I am at A&E Singapore General again, this time for myself because the second round of antibiotics has done little. Instagram has released snapchat filters today and I amuse my parents by giving them flower crowns and puppy dog ears.

There is a poster on the wall promoting Oustanding Patient of The Year. Because everyone here is so miserable, I am determined to be outstanding, articulate, good-humoured. I talk openly in the waiting room about housing, alternative lifestyles and sexualities with my mother who is old-fashioned and horrified, but also used to her daughter’s peculiarities. I like to think I’m raising the consciousness of everyone in my vicinity because a few people around me have stopped playing with their phones and there is noticeable listening silence.

When it is finally time for my examination, I can tell Doctor Five needs a cigarette. I want to tell him about the corner I found the last time I was here, but he probably knows it. He and I are what they call ‘racial minorities’ in Singapore. Only he is more obviously Indian and I… well… the computer screen with my records, I am looking at it intently because it states that I am a Chinese woman, and have been for some years. I laugh and point this out to my mother. Doctor Five is quick to tell me he did not key in that information. I assure him I don’t mind. No one ever gets it right. No one ever thinks to ask me what I think anymore. It’s rude somehow to give me a choice.

Outside, an Elderly Indian Man, whose hospital bracelet is green not white like the rest of us, he’s shout-talking. The staff and patients are divided in how they feel about him, even behind the closed door of this examination room. I suspect he’s a regular. Lucky for him, today he’s sitting next to an Elderly Chinese Man and his friend (son?) who are comfortable small-talking loudly with him. Elderly Indian Man tells them which staff are nice and which are lousy. That the constituency he lives in is lousy.

“Prime Minister’s constituency! Lousy!” he yells. “Where?” says Doctor Five from where we are in the next room. “He lives in Ang Mo Kio,” I reply and we exchange a shit-eating grin. Nothing amuses Singaporeans more than hearing other Singaporeans complain.

When it comes down to it though, Doctor Five wants to release me. And I am sick and tired and stand my ground. “I want a blood test,” I say. I’m not asking. We return to the waiting room next to Elderly Indian Man and Friends, who are now discussing which food is damn good and which is lousy. EIM knows his shit. He starts telling them about the best turtle soup he’s ever eaten, a dish which must have been in fashion in the 50s because I’ve never tried it.

“Aiyah! That’s why you sick. That’s why you here. You eat everything one,” laughs Elderly Chinese Man.

 

16th May 2017

Doctor Six is a scheduled appointment. My psychiatrist. I ask him if maybe my lymph nodes have gone crazy because I stopped taking my night meds. Unlikely, he says, but (damnit) we spent so long figuring out the best routine and dosage for you. My psychiatrist is perhaps the only doctor I enjoy being chastised by. Maybe it’s because he was a former member of the party. That party. He knows what it means to have straddled worlds, and what we do and choose to do to survive.

He accesses and examines my records on the government interwebz.

“So I did a blood test, and it’s definitely a physical response. To something bacterial. Not viral.”

Doctor Five had been contrite when the results came out. Yes, the problem was there. Had not gone away. Now please, he seemed to mind-project to me, let me get on to the old ladies out there who sakit in the knees and can end my shift. While I’m here, I’d like to try out being in a wheelchair, I mind-projected back. Coming out, a Caucasian man in the waiting room says the exact same thing I’m thinking out loud to a friend. “He has the right idea,” I tell my mum, and he smirks at me. The fun idea anyway.

“Is this all in my mind? Like stress? Could I will my lymph nodes into acting like this?” I ask Doctor Six.

“No.” he says, writing me a referral, finally, for an ENT (Ear Nose Throat) Specialist.

 

— May 2017

Doctor Seven, you are so pretty. Your Kate Spade handbag is a little luxury-basic, but I don’t mind. By now I’ve finished three courses of antibiotics back-to-back. My stomach feels like it’s been hit by krav maga assassins in my sleep since April. But my lumps are gone, and I tell her.. Well, I’m not sure if you’re going to see anything.

“Maybe not, but let’s do it.”

An endoscopy is when they stick a wire with a camera and light down your orifice (or up) to see what’s inside. If it sounds like a bad sex joke, that’s because it is. Have you heard about the one where the nose virgin gets impregnated by a monster butterfly? I tell myself, I’m going to be the best patient she’s ever had and I don’t move. Lie still and think of England.

I am her best patient and she praises me for my stillness, but finds something that hurts like hell in my right nostril. She says she’s taking pictures and she’ll show me in a bit.

“Please don’t be cancer. Please don’t be cancer. Please don’t be cancer.” I think.

The pictures look pornographic, not medical. It’s a plethora of vagina openings in there and I marvel at the beauty of my internal architecture. “You have beautiful vocal chords,” she murmurs. Thank you, I blush – feeling awkward that my father’s outside in the waiting room.

“This is what I wanted to show you,” she says, “You see this gap here that’s narrower? That’s why there’s pain. But it’s muscle. Trauma-related. Were you ever hit in the face as a child?”

Later I ask my father if anything happened to me that my parents have not told me about. No! he says laughing. But Doctor Seven told me, I was definitely not born with it though. And if I have trouble breathing some day to come back for surgery.

I have sinus the rest of the day and have the foresight to carry a box of tissue with me everywhere, including to see Tango by Joel Tan – a play about gay parents and parenting in Singapore. The show is tightly focused and makes statements as much in the viewpoints it explores as the viewpoints it refuses to. But I am appreciative of the gentle breadth it tackles. When I bought the tickets from a friend I told her, it’d be the first Joel Tan play I’d seen since a table read in university when I’d told him exactly what I thought of the work (it didn’t go down well, but I regret nothing).

“I’m bored and triggered by middle-class liberalism that’s not self-aware,” I explain to her. “But I’m willing to step into a Joel Tan creation now I think. I’m less niao now, I think.”

There are many merits to the work that lots of people have written about, all of which by the end of the play I concur with. So I’d rather mention the implicit point of this play, that is that even as we try to break down barriers, there’s still a pecking order to what we fight for in the effort to make a more inclusive society. And rich gays go first. At the end, the life the lead couple have is both emotionally, financially, and intellectually rich (fraught?). One is not so sure if their options are viable for the other queer and poor characters without such resources and privileges. Basically, when you’re rich, you win in a Joel Tan play. It’s pretty depressing for everyone else.

I walk around with my tissue box like I have the plague but I am thrilled that I’m experiencing the sinus of health. At the end of the night, I hug everybody(!) because I think I’m going to be okay(!) except Joel, preferring to thumbs up from a distance. After all these years, he still looks at me like I might give him cooties or a scolding. Or worse.

 

7th June 2017

Doctor Eight, is my childhood doctor. This day is too emotionally draining to recount, not because of him but because of things that happen on the internet. By now, I’m also back at work, operating through my pain, but mostly I stare at the wall (digital and physical) questioning my behaviour. To have ideals is to be lonely. Nevertheless, I am sent private messages from friends – acquaintances I should say really because I don’t have friends in the traditional sense. Many of them say they wish they’d jumped in before it turned into a thing. Some mourn the loss of a certain openness but also rigour, of sincere engagement, that the internet promised us all when we logged in for the first time.

A few try to tell me (with the best of intentions, which are also sadly worse for it) that I’m asking for it.  I wonder if there’s such a thing as ‘sluttiness of thought’. I try not to smile when I read what people have to say about the meanness, the invisible witch hunt, the self-indulgence the incident reveals. It’s too easy to label free-thinkers, trolls. It reminds me of Joel’s play. They, under the bigots, the uninformed, the uncurious, with their #unpopularopinion. In every generation, there is a silent minority. They aren’t people with likes, but they are people with dreams a little more progressive than the ‘progressives’ we have. But it’s harder to stick to manners, KPIs, relevant language even when those dreams are so far above the #basic.

 

10th June 2017

Doctor Nine is not a doctor. Rather they are a nurse, hygienist, and dentist. Now we’re grasping at straws. Bacteria, Doctor Eight says, enters the bloodstream most often through the gums. A chest x-ray has ruled out TB and lung cancer which is wonderful news. But it still doesn’t tell me why I’m sick. But I do know because of my current conditions, the steroids Dr. Turk (Doctor Four) gave could have killed me because they’d lower my already shitty overreactive immune system and that I’m lucky. This may be useful information for Doctor Ten.

Doctor Eight, who I should write about fully one day because he is so gentle, he says that all we can do is monitor now and hope for no more flare-ups. My lymph node is now a rather mobile marble, rolling around in the deep of my throat.

“Are you sure I couldn’t be willing myself to be sick somehow? Or born with a condition?”

“Well, it’s either that or something auto-immune –”

(‘O’ level Biology flashes in my mind. My body is attacking me from the inside ‘by mistake’. My body is a traitor. Fuck you, body)

“– but I don’t want you to worry about that for now. Let’s just get your teeth cleaned.”

Doctors Nine they clean. I gurgle. I spit. The nurse overfills the little paper cup, but frankly this is the fanciest of all the medical facilities I’ve been to. It even has a TV screen on the ceiling playing nature clips in slow motion to distract you while you’re in the dentist’s chair.

They x-ray.  I have yet another cool picture of my body, but it tells me nothing I don’t already know. I’m asked to come back because I need fillings. We all need fillings, no? Before I leave, the dentist of them asks: Are you happy with your smile?

I haven’t been able to work consistently because of all this health shit so I’m low on cash and my parents are paying for all the bills which makes me very very guilty, since there’s seemingly nothing to show for it. The last expensive thing I bought were those Tango tickets which left me with $30 in the bank. Hah.

“Dude, that’s a loaded question.”

A Mild/Medium

I’ve put off a lot of things. Including writing. Including writing here. Partially because the last three weeks I was getting somewhat better at prioritising what needed to be done. But then, a lot needed to get done. The To-do list never stopped.

I started a ‘To-Done’ list in my head to deal with the mounting To-Do. And I just stalled from there. I don’t feel compelled to ‘do’ to be ‘done’. I’m forcing myself to write this because it’ll be the first thing on my ‘To-Done’ list since… a week ago?

That’s not really fair. It’s more like four days. I know this because H has gotten me to record everything I do for every hour of the day (except between 4-8 am) for the past three weeks. It’s been rough and eventful, and I can see three trends which I need to accept.

1. I actually do get a lot more than I think done. But I give myself far too much to do. I set myself up to fail myself and others this way.

2. I have an obsessive-compulsivity for everything to be ‘just right’ in order to move forward. And because everything in this world is variable, I get weighed down and scared to do anything beyond the constants I can keep.

3. Because in the past few weeks, I have had substantial fluxes in life-depending categories (romantic relationships, the internet, health, employment), the only constants my body is able to do is smoking, keeping absolutely up-to-date with Instagram, and steadily reading/finishing Bitch by Elizabeth Wurtzel (written in 1998, but still so uncannily relevant).

Re: Relationships, I got tinder. For a brief time, I lived out my female stud fantasies. It truly is a wonderful piece of technology (if you’re a hetero woman, since 95% of it is all dudes of varying instinct and desire, which you can competently weed out with texting). Then I got back together with my partner of the last six(?) months. We met on OkCupid and he was the first person I’d ever met from the site, which made me think for the longest time that because we’d latched on to each other, that I hadn’t made an informed choice. I was also arguably insane at that point, dependent, and very close to being committed to a ward again for ‘exhaustion’. It’s always ‘exhaustion’ in Singapore, if you’re a nice, middle-class, educated, local. Even the boys with their slash marks at their necks. It’s never a suicide, because suicide here is illegal. Trust the state to control everything including your will to live. Anyway. This second go at things is perhaps the most functional thing I’ve managed this month. It helps that he is and has always been patient with me. He bought me a box of dates yesterday because I wasn’t eating well and said, Now you don’t need tinder anymore! (Lol. When bae tries to be funny)

Re: The Internet, was broken. But I fixed it. Arguably it put a sudden stop in my workflow. But it’s been fixed for a week now and I just can’t bring myself to answer my emails or get work done. I’ve also had emotional flares to do with upsetting content I’ve seen on my feeds including, but not limited to, shoddy journalism, misogynist and plain stoopid photos from colleagues, pictures of babies alongside stillborns in the run-up to Mother’s Day. This deserves a post on its own and so I won’t comment further.

Re: Health, I’ve developed a lump (lumps?) in my thyroid. It comes and goes. Swallowing gets painful. I had no idea as human beings we naturally need to swallow so much, all the time. At its worse, I’m afraid that it’ll swell up til I stop breathing and die in my sleep. I’ve been to three different doctors. All of them said it was viral, but gave me two courses of antibiotics which I’ve finished. The next step is A&E to do a scope, the last guy said. Also because it was 4 am and he was young, he told me, “I know this sucks. I’m sorry it’s gonna be a bitch to swallow all these pills.”

(I’m 29. It’s now become adorable when doctors in hoodies, fresh out of school, have that semi-getting-fresh bedside manner with you.)

Now that it’s showed up for the fourth time in two months, I’m thinking of just waiting for my appointment with my psychiatrist on Tuesday, since I see him in a hospital anyway. It’s possible that this is psychosomatic; that I’ve thought myself into so much rage and anger and sadness that my hormone-makers are overworked. In the meantime, I’ve been collecting all the spare Anarex in the house. My diet is now all liquid and pills, what I usually have to take notwithstanding. Knocking out pills like shots is itself depressing.

Re: Employment, I started another freelance job. But it’s more like a full-time job from home. I am very grateful. These people answer emails and pay on time, which is a joy in and of itself. But I hate myself for disappointing them with all the shit I let pile up that stops me from being #supereffective. Granted, the #lumpofevil has been a real doozy to get around. I’ve had to cancel some voiceover jobs over the last few weeks which is frustrating.

I don’t know if writing all of this down has been the cathartic exercise I’ve needed to reboot. But I sure hope so.

It is 10.59 pm on a Sunday and tomorrow – which is in another hour – is another day.

Notes I.

Notes from “Mental Health and Psychiatry in Singapore: From Asylum to Community Care” by Kah Seng Loh, Ee Heok Kua, and Rathi Mahendran in Mental Health in Asia and the Pacific (Springer US, 2017)

“The shift from asylum-based institutionalisation to community psychiatry and the recognised importance of mental health are definite signs of progress. However, the continuing dominance of Western frameworks of psychiatry ignores both the rich experience of clinicians based in Singapore as well as the varied customary way in which Singaporeans have viewed and treated mental illness.”

Pre-war era – Occupational therapy common, but main focus was incarceration and separation from the general public. Therapy available to the very upper classes with emphasis on health. But most early mental patients were vagrants and destitutes removed from the street by colonial powers and detained in Convict Goals. Colonial emphasis on illness rather than well-being, and as symbolic of moral and material degradation. Asian perspectives generally leaned toward mental health as a spiritual problem, to be dealt with by witch doctors and traditional healers.*

1947 – 1950 – New physical methods of treatment introduced including electro-convulsive therapy (still used today) and insulin coma therapy.

1952 – 6 doctors, 1 matron, 8 nurses, 10 assistants to serve 1,700 patients a year.

1951 – The Mental Hospital is renamed Woodbridge Hospital after a bridge in the area named by the Chinese as ‘pang kio’ or wooden bridge. Politically-correct euphemisms however do nothing to reduce old stigmas.

1953 – First outpatient psychiatric clinic was established at the General Hospital for ‘less serious cases’, followed by four more clinics at other hospitals through the decade.

1954 – Push to recruit Chinese-speaking psychiatrists to replace expatriates and non-Chinese doctors as part of Malayanization of civil service.

1955-1958 – Social work department added to Woodbridge Hospital and introduction of social therapy – encouraging patients to take part in social and recreational activity such as group singing, dancing, discussion, film-watching.

1960 – Amendment to the mental health law allows doctors to admits patients into Woodbridge, as increasing numbers were going directly to government hospitals. In 1965, of the 2,797 patients admitted to Woodbridge, only 581 were voluntary cases.

1965 – Postcolonial health still racialized: “[The] Malay is more conservative and prefers to seek native treatment… Alcoholism is rarely encountered among the Chinese and Muslims… the Chinese usually drink with their meals or when entertaining their guests and here again food is served. Perhaps this social habit of drinking while eating presents them from becoming chronic alcoholics.” (1965 report from the Ministry of Health)

1968 – Child Psychiatric Clinic established in Woodbridge. Also an Association for Mental Health (an NGO) to promote mental health and provide daycare facilities for discharged patients.

1979 – Department of Psychological Medicine established at the National University of Singapore, based in Singapore General Hospital, and later moved in 1987 to National University Hospital. This was the first general hospital department of psychiatry.

1983 – Government decides psychiatrist training should be localised (previously would-be practitioners completed post-graduate work on scholarship at the Institute of Psychiatry, London), and NUS (with assistance from the UK) offered a Masters in Medicine (Psychiatry)

1993 – Woodbridge Hospital and Institute of Mental Health is built at Buangkok Green, with government stated aims towards therapy, training and research, rather than the custodial management of patients.*

2000 – Woodbridge becomes integrated into the cluster of hospitals called the National Healthcare Group. Elsewhere in Europe and Australia, efforts are made to close asylums.

2002 – Psychiatric departments in all the general hospitals and increasingly polyclinics, but public preference for care from the private sector due to long wait times, stigma, and a misplaced desire for privacy.

* Ee Heok Kua on ethnic perspectives towards mental health in Singapore from “Focus on Psychiatry in Singapore” in The British Journal of Psychiatry, June 2004.

“Family structures and cultural beliefs often determine illness behaviour and help-seeking tendencies. In a study of illness behaviour in 100 Chinese patients referred consecutively to the psychiatric clinic at the National University Hospital, it was found that 36 had also consulted a traditional healer (Kua et al, 1993). More women than men felt that their illness was due to spirit possession; but belief in possession was not related to educational status.

Classical Chinese medicine is based on the belief that there is a finely balanced and rhythmic relationship between bodily functions and the emotions. This belief is built on the concept of yin–yang, a bipolarity that is both opposite and complementary. The yin represents coldness and yang warmth. When this homoeostasis is disrupted by spirits, mental illness might result. In the family it is often the elders who seek help from the traditional healer to intercede for the patient to exorcise the spirits. If the traditional healer fails, the family might then consult a general practitioner who will refer the patient on to the psychiatrist if he has difficulty with his or her management.

The possession-trance is a common culture-related phenomenon in Singapore and many countries in Asia. I have previously reported the characteristic features (Kua, 1986). People prone to this condition are often from less-advantaged backgrounds and have received poor education, they have previously witnessed a trance and the onset is usually before the age of 25 years. During the trance there is evidence of an alteration in the level of consciousness, and stereotyped behaviour of a deity which has possessed the person. The trance lasts for less than an hour, and is followed by physical exhaustion and amnesia for the period of the trance, with normal behaviour in the interval between trances. The young men in the study had these experiences soon after enlistment in the army, which was perceived as a stressful life event. Because possession-trance is not deemed an illness, a traditional healer is often consulted. This socially sanctioned behaviour is recognised as a sign of distress and evokes the appropriate family response of support and sympathy. The individual is treated with respect because he is perceived to be favoured by a deity. The healer shares the same belief system as the family, whose trust and hope are powerful factors in the treatment. During the therapy, the healer goes into a trance himself and the family participates in the rituals. This phenomenon can be explained as a defence mechanism to preserve self-dignity and self-worth. Treatment by the traditional healer lacks the stigma associated with referral to a psychiatric hospital.

The Malays and Indians have their own priests or healers who are consulted not only for spiritual matters, but also when someone is ill. Among the different ethnic groups, there are other culture-related conditions such as amok and koro which are less common now. One of the earliest reports on amok was written in 1893 by the British psychiatrist in Singapore, Dr W. G. Ellis. He concluded that amok was a homicidal–suicidal rage due to depression. The patient would often describe his mood state in the vernacular as sakit hati or sickness of the liver, the organ regarded as the seat of the emotions (Kua, 1991).

Because of their cultural beliefs, patients who seek psychiatric treatment will take medication from their doctor and also a herbal prescription from a traditional healer. Sometimes patients with schizophrenia who seek help from traditional healers are referred for psychiatric treatment after a delay of 2–3 years. With public education, we have noticed recently that the majority of patients with first-episode schizophrenia (80%) are referred to the National University Hospital within 6 months of the illness onset.”