Sunday, June 22, 2014

A Rock And A Hard Place?

This entry deviates from my usual recreational posts. But a recent healthcare-related issue is bothering me significantly and I need to write something about it.

The last thing I need is a phone call or email from one of my big bosses. :)

If you follow the news, you're no doubt aware of the recent revisions in healthcare coverage, in terms of Medisave and MediShield benefits.

While it is a timely move welcomed by many, I have reservations about this sort of "crowd-pleasing" tactic.

In addition, the government isn't addressing serious problems which contribute to poor personal health management, instead focusing mainly on healthcare expenditure and how to ease Singaporeans' burdens.

The nature of my work in the Emergency Department puts me in close contact with tens of thousands of patients each year. We don't need detailed statistics to know that
1) Many patients are aged 75 and above.
2) People are getting much sicker, and
3) A significant number don't bother to comply with prescribed treatment or lifestyle modification advice.

While a proportion of those in (3) have financial constraints, there're many others who behave in this manner due to lack of insight, stubbornness, or even plain stupidity.

Every day, I see at least a few active smokers with known histories of coronary artery disease, asthma or chronic obstructive pulmonary disease (COPD), coming in for angina and wheezing. When I tell them they're not supposed to smoke in view of their pre-existing conditions, the standard response is a sheepish grin, and comments like "Yes, doctor, I KNOW I should stop smoking, but it's SO HARD." And they always find it very amusing, like a joke which we should laugh at, hahahaha.

Then there're those who default follow-up and treatment, saying they have "no time" or "I felt fine so I didn't come back lor". Patients sometimes cite lack of money as a reason, then whip out their iPhones, iPads and other gadgets, or sometimes, a designer bag. I'm tempted to search for them on Facebook to see if they've been going on overseas holidays as well.

20 years ago, I was asked during my medical school interview whether smokers who get lung cancer should receive healthcare subsidies. Being young and naive, I replied yes, and that these would be adequately supported by the Medisave, MediShield and MediFund schemes.

2 decades on, my cynicism and constant frustration make me say otherwise.

Should recalcitrant patients be afforded the same level of subsidy as those who obediently follow their doctors' instructions? The former also tend to clog up the EDs and occupy inpatient beds, in addition to having lower quality of life, thereby sapping more healthcare and community resources.

[ p.s. I am excluding patients with cancer from this discussion, as their aetiologies are widely variable and can't always be attributed to lifestyle choices. ]

Should our government help people who don't even bother to help themselves? Shouldn't patients with such cavalier attitudes about their health be penalized in some way? Maybe arm-twisting tactics are the best solution?

Implementing a monitoring system isn't impossible. Proof of clinic attendance is straightforward, and failure to show up should prompt a phone call and an entry in the computerized records.

As for lifestyle modification, how about making it compulsory for all patients with newly diagnosed or poorly controlled diabetes mellitus, hypertension, hyperlipidemia, asthma and ischemic heart disease to attend health education classes and join support groups, instead of engaging them only during hospitalization and clinic visits? Again, attendance should be marked, and absences met with penalties.

Patients' families should also be roped in. I really can't understand why many young, well-educated Singaporeans show no interest whatsoever in their parents' conditions. There've been many occasions where they don't know the diagnosis, treatment ( including surgery ), medications, or whether their mother / father has been taking his / her medicine. Even the patient doesn't know s/he underwent coronary artery bypass surgery. The definition of informed consent in this country is really quite unfathomable.

Families can do a lot to support a patient's lifestyle choices and compliance to therapy, and should be educated in a comprehensive manner instead of given brief, verbal instructions, 90% of which they forget within a day.

As for cigarettes, I strongly suggest the government take some definitive action and impose high taxes on these products. Nobody gives a crap about those ugly pictures on the packages, or those preachy print and TV ads. The ONLY way you can stop people from smoking is by making the prices of cigarettes so insanely high that no-one can afford them. And of course, step up border patrols to deter smugglers.

Singaporeans' ballooning body mass index also has not escaped my attention. Earlier this week, I attended to an 11-year-old girl who weighs 8kg more than I do. And everywhere I go, I see people stuffing their faces and bursting out of their clothes.

Enjoying your food is one thing, but these days, it seems the Singaporean mentality encompasses everything excessive - eating, spending money, enjoying life. Are our leaders aware of what's going on, and will they do something about it?

If the answer is no, then make sure you build more hospitals and hire more doctors and nurses. And prepare yourself for a catastrophic decline in national health, and its long-term effects on the economy.

Friday, June 13, 2014

More Viewing Bliss!

I take immense pleasure in writing today's entry, because I'm reviewing a film which is so incredible it's shot up my list of all-time favourite movies, hitting #2.

It is second only to Dead Poets Society ( which may never be dethroned ), and also ranks as my fave animated film, kicking Pixar's very worthy Finding Nemo to runner-up position ( sorry, Nemo, you've been up there long enough :)).

It is, of course, none other than How To Train Your Dragon 2. It just opened officially at cineplexes yesterday, but for some reason, was locally available for previews a week earlier ( not the usual midnight / weekend shows, mind you, but throughout the entire day ).

I couldn't pass up the chance, after being blown away by the 2010 original - which I saw at home much later, 'cos I knew nothing about the books it was based on.

The impact it made on me was tremendous. Everything came together so perfectly, from the script to the visual effects. I even forgave the ridiculous accent discrepancies ( Hiccup and his friends sound American, while the adults are Scots!? ) because the vocal performances were so wonderful. John Powell's score made the whole movie soar ( and reduced me to tears multiple times ), and the beautiful bond between boy and dragon - the beating heart of this masterpiece - moved me beyond description.

After 4 looooong years, I was - like millions of fellow fans around the world - DYING to catch the sequel. But I also shared the apprehension expressed by many. Would part 2 be able to reproduce its predecessor's magic? Could anything possibly top the awesomeness of part 1? And should we leave the tissues at home, or bring a box of them?

The happy answers to these questions are yes, YES, and definitely a box!

The following paragraphs include a few spoilers, so you've been warned. If you prefer not to read on, then take my advice and GO WATCH THE SHOW IMMEDIATELY. Then come back and finish the rest of this entry. :)

I don't read the HTTYD books so I can't comment on how faithful the movies are to the original stories. I'm quite certain liberties were taken by the producers and writers, but fortunately, the results are stellar.

So much is packed into 90 minutes, I was horrified when my bladder started acting up in the last 20, and practically sprinted to and from the toilet, making it back just in time to see the final, spectacular showdown between good and evil.

But I digress. What I'm actually pointing out is that the allotted 1.5 hours are super-efficiently utilized, making me ponder why most Hollywood films these days insist on exceeding the 2 - or sometimes 2.5 or 3 - hour mark, causing viewer fatigue ( though I admit there's better value for money ).

I realize cartoons rarely cross the 100-minute mark for obvious reasons ( try wrangling a restless kid in the theatre ), but with the majority of mediocre animated fare that gets churned out every few weeks or months, a release like HTTYD effortlessly towers over the rest of the pack.

Like all sequels, it obviously has to go bigger - more dragons, more jaw-dropping flying and battle scenes, new characters and conflicts. Hiccup and gang are 5 years older and look great ( the former even has fine stubble on his chin, with lots of close ups for the teenage girls in the audience :)). Hiccup's long lost mother reappears ( voiced by the lovely Cate Blanchett ). A motley crew of dragon hunters threatens the peaceful creatures' survival, and the villain is appropriately vile.

Last but not least, Hiccup and Toothless' relationship ( calling it a simple "friendship" wouldn't do it justice ) is tested once more - or more accurately, twice - when Hiccup has to find a way to save his beloved companion from a powerful enemy.

While HTTYD 2 has all the requisite ingredients for guaranteed box office success, much credit goes to director Dean DeBlois ( who also helmed Part 1 and co-wrote both screenplays ). Because we all know execution is key.

DeBlois strikes a perfect balance in every scene, letting it run long enough to keep us enthralled but not too long to cause distraction. The funny segments are hugely entertaining, but he truly excels when poignance takes centrestage. And there are many such moments scattered throughout the film, mostly involving Hiccup, his parents and Toothless. Inducing tears is one thing, but my heart was literally bursting out of my chest! I was so profoundly moved, especially during the last 15 minutes when Toothless' full strength was revealed, and his deep love for Hiccup gloriously displayed.

Finding Nemo came close in this respect, but HTTYD 2 surpasses even that.

Adults will have no difficulty appreciating its mature themes. As for the kids, I hope that 5-10 years down the road, they will watch this again and find new things to love.

Fellow fans rejoice! Because HTTYD 3 has been announced, and will hit the big screen in 2016 ( only 2 more years instead of 4 woohoo! ). Hiccup will be the big chief ( and probably married to Astrid ), and I have a strong feeling about Part 3 including a story arc about Toothless finally discovering another of his kind. A mate, perhaps? I'm getting goosebumps! :D

Before signing off, I'd also like to mention another reshuffle in my fave movies list.
After a recent repeat viewing of Independence Day, I've decided to place it at #3 - indeed, just below HTTYD 2.

I admit it's a little shocking, because the previous top contenders mostly comprised serious material ( e.g. The English Patient ). Perhaps HTTYD 2 hit a nerve, but I found myself beaming ecstatically just a few days ago, despite having seen Independence Day countless times these past 20 years. I was most struck by how it's remained so thrilling after 2 decades, bringing together a superb cast ( I still have the biggest crush on Bill Pullman, who is IMHO the best big-screen American President ever ), a rousing story, eye-popping visual effects and some of the most spectacular action sequences in existence, to create a work of art which I never tire of.

And that, I suppose, is the main reason for my current top 3 selections - they're all terrific movies, but more crucially, ones I can watch again and again without losing interest. Plus, they beautifully illustrate life's various ups and downs, teach important values, and boast satisfying, memorable ( though imperfect ) endings.

My writing aspirations are on hold for now, but if I ever get round to penning something ( hopefully before I become too old and tired ), these will be my gold standard. I'm not saying I can match them - please, my ego isn't THAT inflated! - but I will certainly keep their good points in mind for any story I consider.

I do wish I could see HTTYD 2 again at the cineplex, but alas, I'm too busy. And I thought seniority would bring more free time. Turns out it's the exact opposite...

Comments about HTTYD 2 are greatly welcomed. Enjoy, and please share your thoughts with me! :)

Sunday, June 01, 2014

Viewing Bliss!

Today's entry is dedicated to 3 TV series and 1 film, all of which I highly recommend.

The first is NBC's Hannibal. Season 2 has already concluded, but it's worth a mention because frankly, the show completely fascinates me.

The plot twists induce whiplash while talky scenes go on and on forever, but the wildly changing tempo keeps things fresh and surprising, and I never knew how each episode will end.

I shall refrain from analyzing the strange dynamics between characters, other than saying that they border on ludicrous at times, yet somehow remain believable ( though this depends entirely on the viewer ). Hannibal Lecter and Will Graham's constant cat-and-mouse games are nail-biting, and what I initially thought were weird / moronic acts have finally revealed themselves as entirely the opposite.

The addition of Michael Pitt as deranged billionaire, Mason Verger ( who actually appeared in Thomas Harris' sequel to Silence Of The Lambs and was played by Gary Oldman in the film version ), is genius. Pitt is riveting in the role and almost unrecognizable with nerdy glasses, bedhead hair, a cackling high-pitched voice and twitchy posture.

Main grouses? Definitely the romantic subplots. Hannibal and Will both succumb to feminine wiles, which I suppose the writers felt would add dimension to the storylines, but which I find tiresome. Please stop.

The murder scenes are still as creative and artistic as ever, accurately described as intricate tableaux of death. One killer stitched corpses together into a mural, then sprayed chemicals on them to harden the skin, before admiring his work from the top of a grain silo. Another buried his victims inside dead horses, while another removed internal organs and replaced them with fresh bouquets.
Totally wacko stuff - I love it. :)

The finale was absolutely shocking, but I won't reveal spoilers here. In a nutshell, it was a gruesome bloodbath with a significant body count involving major characters, ending with a cliffhanger guaranteed to make you scream, "AAARGH!"

That's what great television is made of, and season 3 was confirmed 3 weeks ago. Congratulations!

Next is FX's Fargo, based loosely on Joel and Ethan Coen's Oscar-winning comedy/thriller. Certain key elements remain similar - the small Minnesota town setting, the constantly miserable weather, a smart and determined female police officer, and at the centre of it all, a hapless dorky fellow whose life is turned upside down, causing him to reveal a previously dormant dark side.

The cast is exceptional, especially Martin Freeman as abovementioned dork. He really nails the character - from the grating accent to the villainous transformation. Like Breaking Bad's Walter White, Lester Nygaard straddles that fine line between good and evil - you wince as he displays moments of violent ruthlessness, but also feel sorry for him as he sinks deeper into the hole he's dug. I guess the most important lesson taught here is that every single one of us is capable of murder, as long as there's motive, opportunity and that little push that tips you over the edge.

Other standouts include Allison Tolman as the suspicious deputy sheriff ( a non-pregnant version of Frances McDormand's Marge ) and Bob Odenkirk ( Saul Goodman from Breaking Bad ) as her gullible boss.

Many new series these past couple of years have opted for a leisurely pace in terms of scene setup and plot / character development, with Hannibal and Fargo following the same format. I'm a huge fan of this particular style ( excluding Game Of Thrones, which has way too many people in it ). Keep it up!

Showtime's Penny Dreadful sounds positively nuts if you really think about it - i.e. a mashup of famous Victorian era literary characters, including Victor Frankenstein, Dorian Gray, Mina Murray and Dracula. The pilot episode set things up; after that, everyone got down to having some REAL fun.

For a horror fan like myself, a show like this can go either way. Aside from True Blood and X-Files, I've avoided most paranormal-themed series because they're either too campy or over-ambitious, or most commonly, feature pretty young casts with zero acting talent.

Penny Dreadful suffers from none of the above. The leads are Timothy Dalton, Eva Green and Josh Hartnett, none of whom is below the age of 30. Dalton played James Bond in the late '80s ( my favourite 007, FYI ) while Green's resume includes a string of Hollywood blockbusters. Hartnett's the least experienced of the lot ( though he, too, had his moment of stardom with Black Hawk Down and Pearl Harbour ) but has aged well and suits the role of hot-headed cowboy, Ethan Chandler, who's recruited to join Sir Malcolm Murray ( Dalton ) and Vanessa Ives ( Green ) as they hunt for Murray's daughter, Mina ( from Bram Stoker's Dracula, get it? :)).

Victor Frankenstein also gets enlisted, with ample screen time devoted to his backstory ( though I find the scenes with his monsters - yes, there's more than one - a little dull ).

The character I'm currently most intrigued by is Dorian Gray. Played exquisitely by Reeve Carney ( last seen on Broadway in the Spider-man musical ), Gray looks like a boy band member but exudes a pulsating undercurrent of menace and wild eroticism. A scene involving him and a prostitute was equal parts disgusting and sensual. A fine balancing act which was expertly pulled off!

Another highlight was the seance in episode 2. Green took centrestage and practically made my skin crawl with her extremely convincing interpretation of a full-throttled demonic possession. Like I've said before, my horror threshold is quite high, so whenever something scares the crap out of me, it's like hitting the jackpot! I'm very pleased. :)

I hear Dracula and Van Helsing will make an appearance soon. The crowd is growing but I'm confident that the show's creator and writer, John Logan, will keep things organized. He is, after all, the man who wrote the screenplays of Gladiator, The Aviator, Hugo, Skyfall AND the next one or two Bond films.
You can't get any better than that!

Last is the film In Secret, starring Elizabeth Olsen, Oscar Isaac, Tom Felton and Jessica Lange.
A brooding romance / thriller set in France, it revolves around sexually frustrated Therese ( Olsen ), who's trapped in a loveless marriage to her cousin, Camille ( Felton ), and bossed around by her aunt ( Lange ). When Camille's handsome and intense friend, Laurent ( Isaac ), enters the picture, he engages Therese in an affair which later leads to tragedy.

The plot isn't that unusual, and the movie doesn't boast major A-listers. But I'm extremely impressed with the performances, especially from Olsen and Isaac. The former consistently wows with her screen presence and maturity in project selections, while the latter recently hit the jackpot with the Coen brothers' dark comedy, Inside Llewyn Davis, and a role in J.J. Abrams' Star Wars: Episode VII.

Isaac is one of my new favourites, after catching my eye in Won't Back Down ( he played a cool high school music teacher ) and The Bourne Legacy ( a glum-faced fellow assassin opposite Jeremy Renner ). But I'd actually also seen him years before, in Sucker Punch and Robin Hood, without noticing him.

Every actor hits his/her stride at some point, so this is Isaac's time. His performance as Laurent is explosive - Isaac scorches the screen every time he appears, and steams it up in his love scenes with Olsen. He also handles the dramatic bits skilfully, infusing them with just the right portions of rage and restraint. Laurent's layers are gradually peeled away, exposing the monster beneath. Isaac is truly amazing!

Before I sign off, a quick mention about another TV show which I've become hopelessly addicted to. Titled Last Week Tonight with John Oliver, it's sort of a spinoff from Jon Stewart's political satire talk show, though I find Oliver's far more entertaining.

I literally fell in love with him when he stood in for Stewart for ( I think ) a month last year when the latter took a break, and absolutely KILLED it! Perhaps the British accent makes everything sound funnier, but Oliver's delivery is also key. He looks like a dorky university professor ( or librarian, it works either way ) but has one of the sharpest wits I've ever encountered. Sure, there's no doubt the show has cue cards ( don't they all ) but there're so many moments when he doesn't even seem to be reading them, ad-libbing snarky comments that make me laugh out loud, not just from a direct interpretation of the joke, but from additional analysis of its other meanings.
Because the beauty of Oliver's humour ( which exceeds Stewart's and even Jimmy Fallon's ) is its sheer depth. He doesn't merely poke fun at a person or a situation, he extrapolates it to all mankind, illustrating our many foibles and follies, yet somehow managing to make it seem cute and totally okay.

And no topic is beyond his grasp, be it food product labelling, Google software, the death penalty or India's general election. The last one's especially fantastic, and I really applaud Oliver's staff for collecting a set of side-splitting clips from Indian talk shows, ingeniously comparing them to their American counterparts.

Yep, we're all a lot more alike than we originally thought!

I'm adding Oliver to my list of "nerd crushes", which currently stands at 2 ( Martin Freeman has the honour of being the other candidate ). It's important to differentiate these crushes from simple admiration / fan appreciation ( that list is pretty long ). Because someone I have a crush on is capable of reducing me to a quivering heap of jelly if or when I come face to face with the person.

I fully intend to try getting tickets for Oliver's show when I return to New York in late 2015 ( yes, again! but it's for a conference in nearby Boston :)). He completes my trio of adorable talk show hosts - the other 2 being Seth Meyers and Jimmy Fallon.

Till next time, happy watching!