Palliative care dept at TTSH (ST Nov 28, 2008)

It is first public hospital to do so; move follows growing need to improve lives of the terminally ill By Salma Khalik

WHEN her father and grandfather died two weeks apart after losing their battles with cancer, Ms Angeline Chew was devastated.

Fortunately, she was able to draw strength and comfort from palliative care doctors and nurses at Tan Tock Seng Hospital (TTSH). They helped the family members come to terms with their imminent loss, while also seeing the patients through their painful last days.

The need for such support has grown over the years. Once offered exclusively to terminally ill cancer patients, palliative care has since been extended to other terminal illnesses such as organ failure. Last year, palliative care doctors at TTSH helped more than 1,400 dying patients and their families, up from 1,100 in 2005.

To cope with the larger numbers, the hospital has decided to set up a department devoted solely to palliative care - the first public hospital to do so. If it works out well, a Ministry of Health spokesman said others would follow suit.

With the change, the current team of four doctors will be able to grow the service with more nurses and registrars, as well as train more doctors in this field, said Dr Wu Huei Yaw, a consultant in palliative medicine at TTSH.

Only about 60 per cent of people who need palliative care are getting it, Health Minister Khaw Boon Wan said recently.

Palliative care doctors treat not only physical symptoms such as pain and breathlessness, but also the emotional and spiritual needs of the patient. They spend a longer time with each patient, with a new case taking anything from 30 to 60 minutes for the first consultation.

The question they most often have to deal with is 'Why me?', said Dr Wu. Patients, especially those in their 30s or 40s, often protest that they are not ready to die.

Older patients, on the other hand, are usually less afraid of death, but they do fear pain and suffering, he added. This can be helped by palliative care doctors explaining what they can do to alleviate suffering.

If the pain gets really bad, they will get anaesthetists to administer an injection into the spinal cord - like epidurals given to women in labour to help them cope with the pain. In extreme cases, a patient can be kept sedated till he dies.

Ms Chew's father suffered from intense pain in his last days. But 'his eyes would light up when Dr Wu or the nurses came by', she recalled.

He knew they were doing their best for him, and was grateful. Dr Wu once returned to the hospital at 10pm when he heard that Mr Chew was in great pain.

Mr Chew was given a 'terminal discharge' after the doctors told his family that there was not much more healing they could give him. Instead, he would die at home, while his pain treatment continued through a home hospice care service.

Dr Wu said an increasing number of patients and their families are opting for terminal discharge.

Last year, more than 50 patients chose to go home. This year, more than 80 have already done so.

Another new department, called Community and Continuing Care, is working with nearby nursing homes to provide their patients with palliative care, so there is no need for them to be admitted.

This is better for both the patient - who does not have to be shuttled to and fro - and the hospital, which faces a perennial shortage of beds.

When first approached some months before her father's death, Ms Chew, who is in her 30s, was upset and rejected their help. Her father was only 57 years old, and the diagnosis of late-stage colon cancer came as a shock.

'I thought the doctors had given up on my father and were sentencing him to death,' the mother of two young children said. 'I couldn't have been more wrong.'

(source: www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_307844.html )

My comments:
I recalled the recent demise of my mother-in-law. She was discharged from SGH around June 2008 and hospice care was given because she was deemed to be terminally ill. Since then, a nurse and occasionally a doctor from Hospice Care Association would visit her weekly, talking to her, ensuring her health condition was still "fine".

Lately, when my mother-in-law was unable to move around, a wheel-chair and a toilet pan were loan. Morphine solution was given to relieve pain and suffering. Just a few days before she passed on, the nurse said that my mother-in-law might be at the last stage of her life and advised her family members to spend more time with her. True enough, my mother-in-law left this world within a week.

Special thanks goes to Debbie, who is so patient, thoughtful and sensitive to our needs.

Boy Jumped over CCA

A 15-YEAR-OLD jumped from the 11th-floor bedroom window of his home - in front of his mother - after a disagreement with his parents over his intention to switch his co-curricular activity (CCA) in school.

http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_307353.html

My comments:
My heart goes out to the mother of this teen. How can the son do such a cruel thing to his mum? Seeing your loved one ended his life yet can't do anything at all is simply the most cruel thing in this world.

I don't think time will heal this wound. A significant part of this mum was gone forever.

Time to do something extra for Forgery Cases

On the same day (25 Nov 2008), I read two articles from Straits Times Online on forgery cases; "Borders staff jailed 4 years " and "Woman jailed for forgery, CBT".

In both cases, both forged signatures on the cheques to direct banks to transfer money into their own bank accounts for personal usages. In the first place, forging signatures is already a serious crime. Secondly, they are taking money which does not belong to them openly. Thirdly, much resources have been employed to prove forgery and to prosecute them in the courts.

Have we forgotten one crucial point that the banks involved which allowed such cheques to clear need to bear some responsibilities? How can such cheques be allowed to clear in the very first place?

The relevant authorities should look into the loopholes in this process before more forgery cases emerged in this difficult times. In addition, I urge severe punishment imposed to act as a deterrent.

Up to 19% pay cut for top civil servants; lower year—end bonus

SINGAPORE: Ministers and top civil servants will get a pay cut of up to 19 per cent next year. The Civil Service is also reducing the year—end bonus payment for this year.

Top civil servants and ministers were supposed to get a pay rise in January next year to bring their salaries in line with private sector pay.

It was to be the third adjustment to bring public sector pay to 88 per cent of the private sector benchmark, a move announced in April 2007.

The benchmark is set at two—thirds of the median pay of the top eight earners in each of the six sectors: multinational corporations, lawyers, bankers, accountants, local manufacturers and engineers.

In April 2007 and January this year, the salaries of top civil servants and ministers were revised to keep pace with soaring private sector salaries. But the Public Service Division said the 2009 salary revision for this group has now been deferred, in view of the clouded economic outlook.

In fact, the annual salary for top civil servants and ministers will fall next year to levels below April 2007, because close to 25 per cent of their annual salary comprises variable payments linked to the GDP growth of Singapore and their salary will fall as long as the economy remains weak.

In 2009, the Prime Minister and President will see their annual salaries cut by 19 per cent. Ministers and Senior Permanent Secretaries will see an 18 per cent fall. The allowance for Members of Parliament will be cut by 16 per cent.

Commenting on the pay cut, Mr Teo Chee Hean, Minister in charge of the Civil Service, said: "Public sector salaries follow the market up and down. The mechanism we introduced last year to link a significant proportion of the salary of senior civil servants to the performance of the economy is working as intended. This mechanism allows salaries to respond more rapidly to market conditions."

The Public Service Division also said the Prime Minister has and will continue to donate all increases in his own salary after the April 2007 revisions, to good causes for five years.

Next year, the Prime Minister will actually see his salary fall to pre—revision levels.

As for civil servants such as teachers and police officers, they are getting a total of two months’ bonus payment this year, plus S$100 to S$300 paid out in July. This comprises the 13th month payment or Annual Wage Supplement and a one—month Annual Variable Component or AVC.

The year—end AVC has been reduced to 0.5 month.

Last year, the total bonus payment was three months plus S$220, including a half—month Growth Bonus which was paid for the exceptional economic performance in 2007.

Public Service Division news release on civil servants’ annual pay

(source: sg.news.yahoo.com/cna/20081124/tap-904-civil-lower-year-end-payment-ser-231650b.html )

My Comments:
I am glad that I am still holding onto a job which means I am still getting my monthly salary until further notice. The year-end bonus is an extra amount of money meant to pay tax and bills or saved for rainy days.

Christmas - a month away

Today is 24 Nov. Exactly a month later, it will be christmas eve and many will be celebrating christmas.

Christmas is not only a day for party, drinks and food. It is also a day to remember our loved ones and spend some quality time with them.

Since the demise of my mother-in-law, I have been quite depressed. I can only keep myself busy with work so that I don't think of her often.

We will only treasure when we lost it.

Friends,
Treasure your parents and loved ones now. Drop your work now and spend some quality time with them. You will never know what is going to happen the next day, week or even month.

My mother-in-law's final moments (part 3)

Around 0255hr of 15 Nov 2008, my mother-in-law finally gave up her last breath. She left this world while two family members were at her bedside.

She was cremated today (17 Nov 2008 9am) in Mandai Crematorium. Collection of ash was done at 3pm.

What gave me a deep impression was when the casket was being wheeled automatically away from us in the Viewing Hall, it gave me a feeling that my mother-in-law was on her way to another world alone. I finally understand the meaning of the final journey.

My mother-in-law (part 2)

Since Wednesday, I have not been sleeping much at night, for fear of receiving a call to break the news.

My mother-in-law's conditions are deteriorating. She could no longer control her bowel. She could not drink or swallow. What left behind are just a set of skeletons and a breath.

The HCA doctor and nurse visited her yesterday. They did nothing except to console the family members. Anybody without any medical knowledge would know that D day is coming.

It is really painful and heart-breaking to see a loved one to be in such a state, so thin, helpless, lifeless.

This is how a person appears at the last stage of its life.