The Unforgettables – Dr Tan’s winning entry

In 2013, Novartis Singapore organized a Social Project called The Unforgettables.

During this competition, the public and healthcare professionals alike were encouraged to write essays on they experience taking care of the elderly and to share tips on how to better take care of them.

Dr Tan’s entry was one of the 4 winners of the competition.

The prize money was donated to RSVP and AWWA.

Dr Tan presenting the check for the prize money to RSVP

Dr Tan presenting the check for the prize money to RSVP

 

 

 

 

 

 

 

 

 

Read Dr. Tan’s entry here:

Realizing mortality

It is often said that youth is wasted on the young. What I think is the root of this maxim is that many of us, myself guilty as charged, do not fully appreciate our mortality until we are forced to confront it. Too often I find myself planning, thinking and most of all worrying about the future not realising that I am making a perhaps naive assumption that the future is going to be there.

I had a patient who was enjoying his retirement by taking a well deserved trip around the world. When he was in Europe, he developed terrible diarrhoea and quickly attributed it to the bad herring. It was however bad enough to cause him to cut his holiday short. The doctor who attended to him at the hotel reassured him that it was nothing more than the offending herring and gave him some pills which made him well enough to get home. When I saw him, he had still not completely recovered. ‘I tell you doc’, he said ‘you know how they eat the herring there? Just cold like that you know? Sure got a lot of bacteria!’ I utilised my most congenial smile and gave him my take on what I thought of cold smoked herring as I went through the motions of what I thought was another typical physical examination. No fever? Check. Not pale? Check. Not jaundiced? Check. No enlarged lymph nodes? Check. Now for the abdomen. ‘Take deep breath’ I said as I placed my hand on the right upper quadrant of his abdomen. Something bumped against my hand. I frowned. ‘Another deep breath’ I said and there it was again, the unmistakable feel of an enlarged liver. The confrontation with mortality is a shocking thing.

‘It’s most likely nothing but your liver is slightly enlarged. You’ll need some tests.’ I said. It is always so difficult to balance giving a false sense of security and causing unnecessary worry. After 2 tense days I found myself holding his reports in my hand. ‘A large poorly-defined mass measuring 3.2cm x 2.5cm x 2.0cm located in segment 7 blah blah blah… hypervascular blah blah blah…’ there it is, what I was looking for. ‘Findings consistent with Hepatocellular Carcinoma. Patient will require further assessment.’ Cancer. The confrontation with mortality is a frightening thing.

I referred him to a Liver specialist and he was subsequently lost to the world of hospital based modern medicine. When I saw him again it was about a year later. He was literally a walking skeleton with a huge inflated tummy. It was like pasting an awfully large balloon onto a stick man. He could not walk, he was wheeled in on a wheelchair by his niece and nephew. He was bright yellow from the jaundice, almost luminous. His breathing was so laboured I almost had my nurse call the ambulance. ‘How are you?’ I said. ‘I couldn’t do it doc’ he said ‘I couldn’t do the surgery and the chemo. It’s too scary. But you know there is this monk in China. I travelled there to stay with him for 1 year. I ate very healthy and he gave me these very rare herbs. See I am so much better! Now that I am well, I want to quickly sign the LPA for my niece so that she can handle my finances for me.’ Lasting Power of Attorney? Now? Wait, did he say a monk in China cured his liver cancer? ‘Before we sign the LPA, I must make sure you understand the implications and make sure you are in the right state of mind’ I said with my most matter-of-fact business voice. A quick check revealed that the amount of oxygen in his blood was only 76%, barely able to sustain life. ‘Your lungs are filling up with water. You need to go to a hospital now.’ I said. ‘What about the LPA?’ He asked. ‘I cannot do it now. You have to go to the hospital. We will do it when you are better.’ I answered. ‘No! You will not see me again!’ were his last words to me as his niece and nephew wheeled him out both imploring him to go to the hospital like I suggested. The confrontation with mortality is an angry thing.

A week later I found out from his nephew and niece that he passed soon after going to hospital. They were both outraged by how he was conned by that monk in China and had insisted on going despite everyone’s disapproval. ‘But was he happy?’ I asked. Hope springs eternal and to drink from it soothes the spirit and mind. Surgery and chemotherapy might prolong death rather than prolong life. What’s done is done and it is what it is. May he rest in peace.

Not long ago I had my first child. He is the most beautiful thing that has ever happened to me. Please forgive the emotional torrent from a then first time parent. He is extremely attached to his grandmother. When my own father saw this, he started reminiscing about his childhood and how he was equally attached to his ah-ma (caretaker). He told us how he would cry and hold on to his ah-ma’s leg every evening when it was time for her to go home. Let’s just say my father did not have very loving parents so his ah-ma was the only source of parental love. He recalled how as a young man, he could not sleep for 3 weeks after learning of his ah-ma’s passing.

I looked at my dad, white hair, balding, overweight, moving slowly and gingerly from fighting the many disease that he has and saw him transported back to the time when he was a laughing, jumping 3 year old boy. Where did all that time go? When did my dad become so old? The confrontation with mortality is a cold thing.

So now when I see my 3 year old boy jumping and laughing I think to myself ‘I used to be like that’. When I see my elderly father struggling to get out of the car I think to myself ‘He used to be like that’. Then I think back to my childhood and I ask myself ‘What happened? How did I get so old?’

The realisation of our own mortality is a powerful thing. It can depress us or it can inspire us.  Through it all, the universe keeps spinning regardless of our struggles that seem so significant to us and probably only us; regardless of how we are remembered or forgotten by posterity. I would like to end off with a quote from a most unlikely of sages, my son’s hero and quickly becoming mine too. The old Turtle Kung Fu Master from the Kung Fu Panda cartoon said ‘Yesterday is history, tomorrow is a mystery, today is a gift that is why it is called the present.’

 

Written By: Dr. Tan Kok Kuan

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