Precious Moments
For the last few days, Stardust and I have been struggling. Or rather, Stardust is well but I have been struggling. It is really hard at midnight when one is already on the verge of crying from overtiredness, to deal with a wailing baby who is already crying from overtiredness.
Today, I received an email that really put things into perspective for me. It made me remember that how blessed I am that Stardust is strong enough to cry.
Culture Shock #4
I am shocked to realise that:It is unacceptable to leave work at 5pm even though there is no more work to be done. One has to stick around until the senior doctors have either dismissed you or have gone home themselves. Even though there are no more outstanding tasks to do on the wards, one has to look busy and overworked. A doctor? Finishing work at 5pm? Impossible! He or she must be a terrible doctor - so irresponsible! This has absolutely nothing to do with good time management or being efficient or maybe having a life outside of work. It's just plain LAZY to leave at 5pm!Thus, if there is little work to be done that day, Singaporean doctors will take long lunch breaks, wander around, go to the library and read journals, have a nap, work on their research projects/presentations in order to kill time.In the UK, if I had to work late - which was not very often - it was usually because there was so much work to be done that it could not be finished before 5pm. On days like these, I would not even have enough time to eat lunch or drink any water.Over here, I work late everyday. Usually it is because of the workload, but there are days where I could go home at 5pm, but I stay late...just because it is expected of me.
Thoughts on the labour process
1. Be prepared. I nicked some disposable incontinence pads from the ward and put them on my mattress along with an old towel. Really glad I did this because when my waters broke in the middle of the night, I did not have any control over it and would have otherwise soaked the bed with liquor! I also packed my hospital bag about a month in advance and prepared a birth plan so that I would not have to answer stupid questions during labour.2. Don't Panic! After my waters broke, it took a while for the contractions to kick in, and even then I was not really sure if I was getting contractions or not. I freaked out for about an hour, ran around waking up the entire household (and possibly the whole neighbourhood), and then frantically rummaged through my cupboards looking for advice from Impey. After MDH calmed me down, we decided to wait until the contractions were roughly 5 minutes apart before heading for the hospital, so it meant I got an extra 3 hours of sleep in before we had to leave for the hospital. In retrospect, I could have waited until the contractions were stronger or more uncomfortable, because upon arrival in the delivery suite, the midwives sent me away to sleep for another 5 hours!3. Epidurals are great and everyone should have them!!! The labour process for me was actually quite peaceful. I had my epidural early - basically I waited until I was contracting at a pain score of 7-8 out of 10 (10 being the worst pain imaginable) for about an hour just to see how much I could tolerate without any pain relief. I had been in labour for 12 hours by then and had only made very minor progress. Most women during the first pregnancy will progress by 1cm every hour, so I had a minimum of 7-8 hours left to go and realised that I would be totally exhausted from the pain by the time it came to the 2nd stage of labour (i.e. pushing time). So, I decided to skip the entonox (laughing gas) and the pethidine injections and go straight for the epidural. It was the best decision ever - because after the anaesthetist administered the epidural, I went to sleep for 6 hours, during which the midwives augmented my contractions using a syntocin (oxytocin) drip. I woke up refreshed and ready to push! I don't know how I would have had the energy otherwise because I pushed for 90 minutes and was totally exhausted by the end of it, even though I was pretty much pain-free the whole time. Additionally, I was very relaxed after the epidural, which also meant that the baby was relaxed as well.
Culture Shock #3
I am shocked to realise that:Most Singaporeans are flexible when it comes to the usage of gender-specific terms in everyday language, that is, the use of the gender-specific terms such as 'he/she' or 'him/her' have become interchangeable. In fact, the speaker may even change the gender of the subject mid-sentence, completely unaware that an error has been made (eg. "I spoke to him and she told me to go ahead."). These errors are actually more common than one would suspect and do not appear to be related to race, age or educational level. I have grown used to hearing my fellow colleagues point to a man and say "I already asked about her pain levels". I have also grown used to patients gesturing towards their daughters and saying "Oh, this is my son."MDH was very confused by this to begin with and wondered if, perhaps, transgender operations were actually rather rampant in conservative Singapore!My theory is that this stems from the fact that culturally there are very few gender-specific words found in the asian languages used commonly in Singapore. In mandarin chinese for example, the words for 'he/her/him/he' (ta) although written differently on paper, sound exactly the same when spoken and thus are effectively gender-neutral. I asked around and it turns out that the bahasa melayu word for 'him/her' is also gender-neutral (dia). I haven't found out what the tamil words for 'him/her' are, but I wouldn't be surprised if they sounded similar as well.
Thoughts from the 16 week ultrasound scan
Oh my did the radiographer just say what I thought she said? She's going to check for the heartbeat first before turning on the scan screen. Well, of course, there's going to be a heartbeat. Right? Right? What if there isn't? Oh, but there will be! But...what if there isn't? Why isn't she turning on the screen yet? Why is this taking so long? Turn on the screen, woman! Turn on the screen turn on the screen turn on the screen Oh my God if you don't turn on the screen right now I'm just going to die right here right now so turn on the screen turn on the...Oh!Okay, there is a heartbeat. This means it's alive! Oh my word, I hope there's nothing wrong with it, there could be just so many things that go wrong during the developmental stages and didn't I just go on holiday 8 weeks ago oh shoot oh shoot all the radiation from the flight and I ate multivitamins as well with vitamin A in it before that and I only just started taking folic acid. I don't drink enough milk, though. All those horrible pictures of malformed foetuses in jars in my embrology textbook why did I eat that pate on holiday and play with those stray kittens I'm such a bad bad bad person...Oh!The baby has a head and four limbs. And fingers. Five. Toes too. Two. I mean, five. The bones look all in the right place and so is the spine (bifida? bifida?) which is plumb normal thank God thank God for spinach. It's got skin and the skin goes...all around the whole body oh good the stomach and intestines are on the inside of the baby the heart has four chambers and it's beating and the blood is going the correct direction there's a brain on the inside of the skull and and oh the baby looks so perfect look it's waving at me and kicking and I can't believe how big it is at 16 weeks and and...I'm a mother.
Culture shock #2
I
am shocked to realise that:Singaporeans are surprisingly ignorant about their own medical problems. One would think that, amongst such an affluent and highly educated population, there would be more awareness of health-related matters. But there isn't. My Singaporean patients seem to be quite disinterested in personal health. I feel like grabbing some of my patients and screaming, "Don't you care?! It's your life we're talking about here!!!"Perhaps my expectations of patients are a little too high. I expect all my patients to be able to tell me or provide me with information regarding the following:1. What sort of medical conditions they suffer from. I am used to hearing my patients reel off all their various diagnoses, counting them off one by one on their fingers. In Singapore, patients need alot of prompting and encouragement to get them to reveal their medical history. Just asking them an open question such as, "Do you have any medical problems?" or "Do you have any heart problems?" is not enough. I have to be very specific and condense everything to simple closed questions like "Have you ever had a heart attack?". Even then, I have encountered Singaporeans who deny having serious heart problems but who have already had major heart surgery! 2. What surgical interventions they have undergone and why they took place. Normally, this is a cue for my patients to tell me gruesome stories about 'going under the knife' and complain about post-operative pain and rehabilitation. Singaporean patients are very reticent about this subject and know very little about what exactly took place during their surgery or why surgery was indicated. Some of them will even outrightly deny that they have had any major surgery, despite having long train-track scars down the centre of the abdomen ("Dunno for what!"). 3. What medications they use regularly for their ailments. Even my most elderly and decrepit patients in the UK would carry a list of prescriptions with them, and if they didn't, they could at least tell me what the medications were for ("A small white pill for my bowels, doctor"). Over here, I'd be lucky if I get a response like "In the morning I take one tablet and in the evening I take five tablets". More often than not, I get no response at all, just a mournful shaking of the head.
Skin to skin
I consider it a great achievement that I managed to get to 35 weeks gestation before finding my very first stretchmark. I shall consider it a battle scar!
Culture Shock #1
I am shocked to realise that:In this country, people very seldom pay compliments to each other - especially to people who are seen as being 'junior'. A good work or good effort is hardly ever acknowledged - and if it is, it is done in such a begrudging manner that one is never sure if a word of praise has been spoken or not. However, compliments may occasionally be paid behind one's back in a surprisingly expansive manner. This is called "avoiding obsequious flattery". It is not called "being unencouraging and unsupportive".The people here are very quick to openly condemn anything that is not to their liking. They will quite happily hurl abuse and revel in making one feel as small as possible. And I am sure that the complaining continues in secret as well. Reprimands, complaints and insults rapidly from mouths that can belabour the same criticisms for over half an hour. This is called "being candid and honest". It is not called "being cruel and rude".
