Looks like I've got a few minutes before my shift starts.

My first day in the ER yesterday was relaxing -- but it was my first day, so I hope I don't end up jinxing myself. I saw about 25 patients over an 8-hour period, most of whom were uncomplicated upper respiratory tract infections, giddiness and the like. A couple of admissions, one nail avulsion for an ingrown toenail, nothing stressful.

Wearing scrubs is the norm here, and they're extremely comfortable -- not to mention a huge saving in terms of time, money and energy, since I can now wear jeans and T-shirts to work everyday, and put those in my locker till I finish my shift. :D Things move really quickly here as well, with cases in the consultation area clearing at super-speed. It's probably due in part to the lack of very sick, complicated cases ( like in hospitals with subspecialties such as haematology, oncology and renal ). But then, the resuscitation room is a whole different ball game -- will have a taste of that this weekend, or Monday, when I'm on night shift *shiver shiver*. :)

Got an SMS from a former houseman ( who's now a new MO ), requesting that I try hard to keep admissions to medicine to the minimum. Hey, I attempt to do that for all disciplines! :D But don't worry. I've been on the receiving end before, and am well aware of some really bizarre cases that somehow get shunted upstairs. I'm working on my "appeasing" skills, so that anxious patients will feel reassured and not insist on admission for conditions that can be managed outside the hospital. But if I do send one or two annoying ones up, it's usually because I couldn't persuade them otherwise.

I'm trying to follow up on my admissions. So if any of you in the wards can feedback to me, I'd appreciate it.

Just adding a couple of terrific links, thanks to fellow Clay fans. :)

Cool interview transcript that provides valuable insight for those of you who want to know more about Clay.

Nice thank-you montage available here. Gorgeous photos!

Lovely thank-you note from Clay here. Signed by him after an interview on Good Morning America yesterday.

Well, it's my last day in internal medicine, and although it'll be a relief for me to get away from the hustle and bustle of the wards and clinics, there's a whole new busy environment down in the ER, with loads of adrenaline rushes and stresses. But it's always been my first love, and I look forward to returning to what I've wanted to do ever since I was a 4th year medical student. I've heard only good things about the department I'm joining, so I'm pretty sure I'll enjoy myself. There're more than 5 fellow MOs who are my ex-med school classmates, so it's gonna be like a mini-reunion of sorts!

Adios to my current colleagues! It's been lots of fun working ( and griping on and off ) with you guys. I wish you all the best in your future endeavours, and for those of you remaining in the same hospital, I'll try hard not to admit any nonsense to the wards. :) You'll still see me around, especially when I send cases up to the ICU, or when I follow up on patients I find interesting. I will miss you all, not just because this is the longest period I've ever stayed in one posting, not because we had to work so closely during the SARS outbreak, but because we did form close bonds while going through the good and bad times, and you're all really fantastic people. :) Keep in touch! We can still go pubbing another time, haha!

I should've bought lottery tickets! My prediction regarding the complaint came true, and just a few minutes ago, someone from administration came by to ask me what exactly happened yesterday. ( She was really nice, so it wasn't unpleasant or anything. )

The last complaint I got was as a fresh houseman, and the way patients' relatives distort the truth still boggles my mind. For example, this particular patient's daughter said the following: 1) that the blood tests weren't ready when I first saw her, 2) that I didn't consult my registrar while her mother was over at the other clinic, thus delaying management further, and 3) that I ignored her when she asked me questions.

Regarding (1), hello, the minute the patient and her daughter sat down, I told them that her blood tests were terrible, which was why I needed to consult someone more senior for help. As for (2), this was merely an assumption, as I was so intent on fulfilling her request to "hurry up" that I called the registrar while the patient was still in the other clinic -- therefore consulting him without the case-notes. Once the file was back on our side, I already had the management plan all outlined. It's not my fault the patient's daughter refused to see me. And (3)? All I'd like to say is: Hahahahahahahahahahahaha. Fellow doctors will know why I reacted this way.

Was catching up on some of my backlogged Time (Asia) mag issues yesterday. One sentence on SARS caught my eye. It said that people who recover from SARS can relapse days or weeks later, while others can be completely asymptomatic yet be extremely infectious. No mention of such cases in Singapore though. Anyone have any idea?

Here's a rundown of the latest good TV shows you can watch ( after Survivor and American Idol ended their runs ):

Alias -- The second season is better than ever, and the latest episode had such a major twist that I actually went "Whoa!". Jennifer Garner has never looked prettier, and Michael Vartan is terrific, as always. Channel 5, Mondays at 11:30pm.

Fear Factor -- The latest season started on Channel 19, AXN, 8pm last Monday, so don't miss it! No really disgusting stunts yet, though, but you can bet they'll surface sooner or later. :D

Six Feet Under -- HBO Tuesdays 10pm. I thought the 2nd season would start last night, but it was a rerun. Will have to check the catalogue for more info. But anyhow, if you missed it the first time round, this'll be your chance to catch up.

C.S.I. -- AXN Wednesdays 9pm. Enough said. Fantastic show, everyone looks fabulous, and the writing's improved in leaps and bounds. ( It was already very good, but it's even better now! )

The Amazing Race 4 -- Starts 30th May on Channel 5 ( 8pm I think ). I've always been a big fan, and this installment has a gay married couple, which is interesting since Singapore considers homosexuality illegal. Are they going to censor things again? Please don't. We're all mature adults here.

Gilmore Girls -- My favourite chick series is back, but I found out only a few episodes after the second season began, darn! Completely missed the episode where Rory broke up with Dean and ended up with Jesse, etc. If you're confused, that's 'cos you're not a GG fanatic like me. :) But even if you're not familiar with the show, you can still watch it for the great script -- witty and intelligent -- the beautiful people, and some clean, wholesome entertainment.

Thanks to all of you who continue to visit my blog, despite my last post being 3 days ago. :D What can I say -- I spent Saturday in the hospital, with little sleep during a busy call, and moved house on Sunday ( with nothing but adrenaline keeping me awake during my multiple trips to and from both houses ). Yesterday, I was officially on a day's leave, and yes, packing and unpacking. The new place is very very nice, and so much quieter than my old home, which bodes well for my upcoming exams. :)

But speaking of exams, I just found out this morning that the preparatory A&E course in July, as well as the local MRCS (A&E) Part 2 exams have both been cancelled! Nooooooo! Concerns about the SARS situation were given as the reason, so the only option is for me to travel to Edinburgh in November to take the Part 2 there. I admit I was crestfallen initially -- I was hoping to save on the flight expenses, plus avoid the below-zero temperatures that Scotland is so famous for. But after speaking to a fellow trainee, we've made arrangements to contact any other A&E MOs who are also taking the exam, and perhaps block-book the airline tickets and, best of all, stay near or with each other. The only major worry I have is the weather, which I'm told can go below zero in winter. The last time I was in Edinburgh was in June 1994. It was summer, but I still froze my fingers and toes off. The wind made things a lot worse. And the rain... I can only imagine what it's like in November!

But like one senior MO once told me, it's a great experience taking the clinicals in Edinburgh, and she greatly enjoyed herself when she went there a year ago. I've got a good friend who's a gastroenterologist at the university, so here's a chance to catch up with him. And thereafter, I hope to have some extra time off to go down to London and Wales, where I've got a few other people I'd like to visit -- Laura, Vanessa and Tom, if you read this, don't leave the country till December, ok? :)
Well, guess New Zealand's gonna have to wait till next year. Hey, hope I get to see real snow during my trip. That'll be a real treat for me.

We had another panhospital SARS update this morning, this time stressing the need for continued vigilance, and good compliance with the wearing of protective gear. Some interesting trends were noted, the most glaring being the fact that doctors have the lowest compliance rate, and nurses the highest. This was worse in non-medical wards, where figures were even lower. But based on personal experience, I can tell you that donning masks that make breathing extremely difficult, and gloves/gowns that suffocate and drench you in a thick film of sweat ( considering the heat wave that's currently ongoing in Singapore ), it's no wonder that some doctors can't comply 100% of the time. Try wearing a shirt, tie and long pants, then the whole set of gear, doing rounds for up to 3 hours at a time, day in, day out, sorting out 50 or more patients' multiple complicated problems while perspiration is trickling down your face and your clothes are so wet they're practically glued to your skin. I've gone through this before, and it is very very unpleasant. Some of the gowns we're given are made of impervious material, so there's absolutely no ventilation whatsoever. So even though we try our best to adhere to the guidelines, the administration also should take note of these limitations, and try to minimize them. Just a suggestion.

I recall mentioning "frivolous complaints" in a recent post, and lo and behold, there was one today. I run full-day clinics now, and most patients and their relatives are very understanding of the time constraints and patient load. But this morning, I saw a sweet elderly lady with complicated medical problems, and who was accompanied by her daughter, a woman in her 30s. Now this patient needed some major sorting out, but her daughter had made another appointment at the eye clinic at the same time, in a bid to finish everything before lunch so she can go to work, I believe. So while I was trying to solve her mother's medical issues, she kept harrassing me to hurry up 'cos they had to rush to the other clinic ASAP. I had no choice but to let them go over first, as I didn't want to be blamed for her "missing" her appointment there. But when her mother was delayed on the other side, the daughter came back here and started bugging me about it incessantly, asking if her mother will still be seen before 1pm, what she should do if there's further delay. And all this while I was trying to clear an overbooked clinic. I asked her as nicely as I could to wait outside so we can sort things out for her, but for some strange reason she got upset, and subsequently refused to come back in to see me.
My stand is always this: if you want everyone to bend over backwards for you, go to a private hospital and pay for this service. The government hospitals are already extremely busy, and the doctors and nurses are working really hard to maintain a reasonable standard of patient care. And with the recent SARS problem, our resources are becoming even more stretched. We don't need prima donna antics that compromise the welfare of other patients. I foresee a possible complaint letter, but I doubt she has a valid case. All right, venting session over. :)

As a side point, the chat room at Clay Aiken's website is getting really crowded nowadays. The discussions are also quite exciting, with regular updates on Clay's appearances and tour schedule, as well as some hilarious examples of mass hysteria -- like when someone signs on as "Clayton Aiken" or heck, "visitor", which prompts others to wonder if it is Clay himself. Or how about the other day, when a fellow user circulated what is supposedly Clay's home number ( in Raleigh ). That caused a major scramble for the phones, which yielded only an answering machine or an announcement that it's a wrong number. Claymania has never been this interesting! But let me also say that the people on the chat are also a wonderful bunch, so don't be surprised if you forge some good friendships through this experience. I predict only more traffic in the future, especially after Clay's CDs are released.

YY, I can't believe you caught American Idol for the first time only during the grand finals! Where've you been all these months? :)

Fear not. Claymania is flourishing as I speak. The chat room at www.claytonaiken.com is even more crowded than before, with fans sharing information, and even giving running commentaries of shows that Clay and Ruben are on -- e.g. this morning, they told me what happened on Larry King Live on CNN. And let me tell you, these "Claymates" are really nice people. Robin is a prime example -- she's a resident of Raleigh ( Clay's hometown ), and her son goes to the YMCA, where Clay used to be a counsellor. As a result, she has close ties with both Clay and his good friends, who also volunteer there. She's been so accomodating in many ways, and so have Clay's pals.

Yep, his friends definitely drop by, and I've met 3 of them already. One of them, Amanda, was on TV the other night -- she was among the 8,000-strong crowd in Raleigh, and was interviewed for a few minutes ( remember the brunette who is "Clay's best friend"? ). She's popped by the chat on and off, and like his other pals who visit, she's amazingly patient and sweet. Imagine trying to answer questions thrown at you by 50 other users all at the same time!

Clay's extremely fortunate to have such wonderful friends and relatives. They're very protective of him, and will certainly keep him grounded through this rollercoaster ride. They also help bridge the gap between devoted fans and a rising new superstar, constantly updating us on his schedule, and letting us know that he's "happy", and that he doesn't want anyone to kick up a fuss about the votes. There're rumours from reliable sources that Clay's first single won't be "This Is The Night" after all, but "Bridge Over Troubled Water" instead, and that it will be released simultaneously with Ruben's single, "Flying Without Wings". No-one's confirmed it yet -- not officially anyhow -- so let's see what happens.

So Clay fans, come to the chat sometime -- I'm logged in as "spacefan". :)

Latest news on American Idol ( those of you who don't want to know better stop reading now )

The winner is.... Ruben Studdard. Yes, I realize that he can't outsing Clay, and viewers in the U.S. swear to me that Ruben was flat during his 3rd song, but that's the way it is, and he got the title.

We're all upset, but hey, Clay made it to the final 2, and to many out there, he's the one with more talent, and future record sales will prove that beyond a doubt. He's also good pals with Ruben, so the outcometonight won't result in any bad blood, just as last year's winners, Kelly and Justin, remain close and have even made a movie together.

The difference was small -- some say 1300, some 130,000, so everyone's confused. Some asked for a recount, but like I said before, it doesn't matter, 'cos to me, Clay is THE American Idol, despite what the polls say.

Anyhow, Clay's good friend, Christie, just dropped by the chat room, saying Clay is fine, and that he and Ruben are being considered as "a tie", so they'll both be given recording contracts, with simultaneous CD releases. Fantastic!

We're so proud of you, Clay! Our congratulations to you for your success so far, and in the future. I've got my running shoes on, in preparation for the day your CD gets to our shores! Great job! :D

Nice collage of photos on the front page of The Straits Times yesterday, depicting a group of men who were caught spitting in public. Keeping in line with the “name and shame” tactic, this is probably the first time I’ve ever seen spitters identified in this manner.

My response: Good one! Spitting’s a disgusting habit that many Singaporeans treat too lightly. It’s about time we put a stop to it, especially in these SARS-troubled times.

But I do wonder how these people got caught in the first place. Inconsiderate citizens all over the country do this on a daily basis, and I’m witness to it. However, I never see policemen around when it happens, so these men either have the worst luck ever, or the police may have been working undercover.

In any case, here’s a tip for the authorities: go to the Heartland Mall area, and you’ll hit the jackpot.


The finals for American Idol 2 have come and gone, but the results are still pending. As usual, I ccouldn't wait for the show to be aired in Singapore today, and have already downloaded the video clips of Clay's performances, all of which were brilliant.

Spoilers alert for those who live outside the U.S.!

Clay's first song was This Is The Night, which I believe is an original composition written specially for the final. I earlier heard it's written by Diane Warren, and it sounds perfect for Clay. It starts out slowly, but the minute he hits the chorus, and his wonderful voice soars with the words "Lift me up", you know he's going to do well for the rest of the night. What a power ballad! This song will be included in his CD single ( which in fact contains 2 tracks ), and is sure to be a bestseller. It may be a love song, but the lyrics "I've been waiting forever for this - this is the night" also reflects his amazing journey up till this point, and serves as the Clay Aiken anthem. Terrific! :)

His second choice was Here, There & Everywhere, written by The Beatles. It's a leisurely, sweet little piece, and Clay is accompanied by a harpist, no less, on this one. Though not demonstrative of the strength of his voice, it shows off his versatility, and his low-key rendition touches the heart. I sang this with the RJC Chorale many eons ago during a concert, so it brings back many memories. Clay's version sounds like it belongs in a Disney cartoon, but that's actually a great compliment. :)

His tour de force, Bridge Over Troubled Water, is appropriately kept till the very end. This all-time classic was written by Paul Simon and made evergreen by Art Garfunkel. Naturally, other artistes have done covers, with the most recent being Russell Watson ( aka The Voice ). But instead of trying to imitate Garfunkel, as Watson did, Clay does his own interpretation, bringing his distinct style to a well-loved inspirational piece, and let me tell you very frankly, it brought tears to my eyes. Whoever did the arrangement deserves a medal. Not only did they give Clay 30 gospel singers as backup, they also redid it with a cool pop / rock feel, and made it all the more enjoyable and uplifting. Clay's range is once again on display, so listen out for the low notes, which are filled with rich timbre, and the high ones ( yes, he ends with one! ), which just melt your heart. Never have the lyrics sounded more poignant -- "When you're weary / Feeling small / When tears are in your eyes / I will dry them all" -- because Clay Aiken has indeed become America's idol, with his radiant personality, his big heart, his beautiful smile, and his splendid voice. He is a great role model for his younger fans, and a great inspiration to the older ones ( like myself ).

If these 3 songs don't seal his fate as the victor in this competition, the votes have got to be rigged. I'll be checking the official website and keeping in touch with American fans online, so once the results are known, I'll be sure to post it here. And if I go a little crazy, please forgive me. :D


I’d also like to add this link to The Charlotte Observer. . Leigh Dyer, who covers all events related to Clay, has been very kind to add my comments to the list. Many thanks!


Well, my day off has come and gone, but I got a lot of things done ( moving house, you see ), and even managed to squeeze in a bit of recreation as well. I finally got my hands on Josh Groban’s concert DVD, which also comes with an 8-track CD that includes live performances of “For Always” ( from the movie “A.I.” ), and the beautiful love song “Broken Vow”. I’ve been playing it over and over again in my car. Pure heaven. :)

Also, I was introduced to David Foster’s latest discovery -- the very boyish Michael Bublé, who sounds like a combination of Harry Connick Jr. and Frank Sinatra ( I kid you not! ). His debut album is sure to give you goosebumps, as he lends his smooth-as-honey vocals to everything from “Fever” and “Kissing A Fool” to “Come Fly With Me”. I particularly love his renditions of "You'll Never Find Another Love Like Mine", “Sway” and “The Way You Look Tonight”, which made me lose track of time while driving today. What a knockout collection of songs! This is one CD you must buy!


And of course, I watched The Matrix Reloaded, which I thought was poetry in motion. Ignore the new-agey philosophical jabbering and you’ll definitely enjoy this movie. After all, it’s the action we care about, right?


Spoilers beware!!!

I was not disappointed, even though I was already blown away by the first installment 4 years ago. Keanu Reeves excels once again as Neo, aka The One, this time more powerful than ever, with the abilities to fly, battle 100 Agent Smiths simultaneously, and yes, even bring the dead back to life. Lean and not looking a day older than 30 ( he’s actually 38 ), he is no doubt the main draw for moviegoers everywhere, and will go down in film history as a cult figure, like Han Solo, Luke Skywalker and Indiana Jones.

Trinity, Morpheus and the Oracle also reprise their roles, but a number of newcomers threaten to overshadow even these strong characters.

The Merovingian, played with delicious venom by Lambert Wilson, gives Frenchmen a really bad name, but adds just that bit of spice and humour to an otherwise dark and depressing story.

Monica Bellucci also ups the heat as his deprived wife, Persephone. The scene where she asks Neo to kiss her, or more specifically, to do so the same way he kisses Trinity, was priceless.

And Jada Pinkett-smith ( Will Smith’s other half ) made a good impression as Niobe, a plucky captain who may be tiny, but sure packs a wallop.

However, the Twins, aka Ghosts, are the best examples of the creative genius of the Wachowski brothers. So-called because of their ability to morph into spirit-like forms, and played to perfection by real twins Neil and Adrian Rayment, these guys are really scary, and had me biting my nails. Wow…

The action sequences are astounding, but even that is an understatement! I’m not sure if other Matrix fans feel the same way, but I thought this sequel was eye-popping. We get to see Zion in all its sinful glory, and the fight scenes are even more amazing than ever. The climactic highway chase has also raised the bar for all future action films, and is flawlessly executed. I just wish the protagonists, especially Neo, didn’t have to wear heavy coats when doing kungfu. Maybe it’s my imagination, but I think it hampers their movements, and makes them look just a little clumsy. Contrast this with Trinity, who gets to wear tight leather catsuits during combat. Now she looks really cool.

So yes, Matrix Reloaded is highly recommended by me, and be sure to watch it on a big screen instead of a smaller one. My personal favourite is Theatre 6 at Great World City – it’s clean, there’s no smell, the leg space is more than adequate, and the toilets are spotless. Plus, That CD Shop is located in the same building – I just love that place. :)

There’re lots of other fabulous movies coming up in the near future – Bruce Almighty ( starring Jim Carrey ) and Charlie’s Angels: Full Throttle, just to name a few. I can’t wait!

Yes, guys, we spoke too soon. Well, actually we didn't. We were hoping, but now that a new SARS case has surfaced here, we've got another 20 days to go before the next possible WHO declaration may occur.

The new patient is a 39-year-old man who's a Malaysian, but who works in Singapore and shuttles between the 2 countries. It's interesting to see the chronology of events during his illness. He had fever for about a week, during which he saw his GP 5 times before being sent to TTSH for further management. He is now in critical condition.

The obviously unnerving fact is this: how did a person with no history of travel to SARS-affected countries or exposure to SARS-affected people, contract SARS? And where exactly did he get the bug -- Singapore or Johor Baru? And why did it take multiple tests to finally diagnose the condition in him?

Implications abound:
That there may be an asymptomatic carrier lurking in the community.
That the bug may have been transmitted through fomites rather than via human contact.
That we may never find the person(s) who passed it to this new case.
That the coronavirus may not be detected in all patients with SARS.

The last statement certainly applies to all patients we see, now that we have a case with no positive contact history on our hands. Just the other night, the A&E Department sent up about 5 cases to the intensive care unit, most of whom had abnormal chest X-rays. Sure, none had any risk factors for SARS, but after this latest case was revealed, will we ever feel safe again? Bear in mind that we don't test every patient for the virus. The question is: should we?

An article by Andy Ho, a Straits Times reporter, attempts to raise morale after this recent hope-dashing event. And I do agree with many of the points he makes. Sure, it's another hurdle to overcome, but we've done well so far, and should continue with our efforts so we can reach the finish line in one piece. Throwing in the towel now would be foolish. And yes, life goes on. A month or two ago, I didn't even dare to go to public places for fear of catching something. I haven't seen a movie since Daredevil in, oh, February? But yesterday's news didn't faze me at all, and when I have my off day tomorrow, I'm going to catch Matrix Reloaded, and go scouting for some CDs as well. :)

And by the way, the story about the "swimming locust" sounds a tad different from the version I heard -- from a Hollywood film, the title of which I can't recall. That one had 2 ants, I believe. After both fell into the milk, one just gave up, sank and drowned. The other fought for his life, and kept swimming till the milk got churned into butter. Just thought I'd mention that.


And now, for some good ol' Claymania. :D Yes, the finals will be airing in America on Tuesday ( which will be Wednesday afternoon in Singapore ), and anticipation is high for everyone who's been following the show. Just visit any Clay Aiken fansite and you'll see the message boards and chat rooms going into major overdrive. You all know I've been rooting for Clay since the beginning, so here's a final recap of his many terrific performances that helped him get to the final 2.

1. The Atlanta audition -- Audiences got their first look at Clay, pre-makeover, where he sang Always And Forever, clad in Coke-bottle glasses, and sporting a less-than-flattering hairstyle ( I'm still clueless as to whether the deep red colour is natural ). Still, Randy and Simon saw past his non-American-Idol image, and let him through to the next round. Good call!

2. The Top 32 -- Clay breezed through the next few gruelling tests to get to the final 32. He sang Open Arms, originally done by Journey. It's a really tough song, but he pulled it off beautifully. Sadly, America wasn't that impressed at the time, and although Clay was in the top 3, he didn't make the top 2.

3. The Wild Card Show -- This time, he sang Don't Let The Sun Go Down On Me, by Elton John, and emerged the audience's choice, beating all the others to go on to the final 12. I stress "audience's choice", 'cos the other 2 wild cards, Carmen and Trenyce, were picked by the judges. This marked the start of the love story between Clay and American viewers, as well as my admiration for his immense talent. :)

4. Motown Night -- He sang I Can't Help Myself, an upbeat and happy piece that made him even more appealing. Simon, however, called it "Motown the musical", in reference to his constant ribbing about Clay's over-the-top vocals. Audiences didn't care, and Clay sailed through to the next round.

5. Movie Night -- His soulfully beautiful rendition of Somewhere Out There from An American Tail had everyone swooning, and Gladys Knight on her feet! This remains one of his very best performances in the competition, and even Simon told him he was the one the others had to beat!

6. Country Night -- A rather boring theme, and the choice of song, Someone Else's Star, didn't strike a chord with me. But once again, Clay's flawless singing was a pleasure to hear.

7. Disco Night -- It was a great opportunity to see Clay dressed in some Ah Beng fashion, but it was his 14 seconds of holding a high note at the end of Everlasting Love that blew everyone away. He didn't dance much though, but that would change in the coming weeks.

8. BillBoard #1 Hits Night -- At This Moment was given a heart-wrenching and powerful treatment by Clay, who made the women scream when he sang "I would get down on my knees and kiss the ground that you walk on". Sigh. :)

9. Billy Joel Night -- Clay chose Tell Her About It, a nice uptempo pop tribute to Motown, and got the audience going without any effort. I thought he would've been perfect for Leave A Tender Moment Alone, another billy Joel classic, but let's face it, Clay would've gotten through no matter what he sang!

10. Diane Warren Night -- His choice of song, I Could Not Ask For More, was a little unusual, since Warren is well-known for writing much bigger hits. Just goes to show how talented he is, 'cos he nailed it anyway, and voters had no problem pushing him through.

11. The 60's / Neil Sedaka Night -- Another one of my favourite Clay performances! Build Me Up Buttercup had never sounded this good till he took the helm! And there was a marked change in his level of confidence, as he relaxed on-camera, smiled cheekily, and even boogied a little during the song. Neil Sedaka told him he'd "kill" to write and produce Clay's CD, and his subsequent rendition of Solitaire sealed his fate, as he once again breezed on through unscathed, while hot favourite Ruben Studdard somehow got kicked to the bottom 3.

12. BeeGees Night -- Clay's fantastic/superb/fabulous ( okay, I'll stop! ) singing of To Love Somebody was rated by Simon as one of the best performances he's ever seen. And for the first time, Clay fans were ecstatic when he shook his hips during Grease. :D

13. Top 3 Finalists Night -- Although he didn't sing Vincent very well, it was through no fault of his own. First, this was a random song pick, as contestants had to draw the titles out of a bowl. Second, there was a last-minute change in the arrangement of the piece, which explained why Clay appeared to have forgotten the lyrics, but in fact, he didn't. He'd merely missed the cue to enter, and decided to wait for the next verse instead. I admire his diplomacy, 'cos the judges crucified him, yet he remained silent and took their criticisms with humility and respect. He once said in an interview that in real life, he always fights for what he thinks is right, but when he's on TV, he makes an effort to keep that in check, 'cos "children are watching", and he doesn't want to project the wrong image of an American idol. But no matter. He bounced right back with Mack The Knife, where he looked right in his element in a cool tux, snapping his fingers to the beat. And who can ever forget Unchained Melody, which will be Clay Aiken's song from now on? Justin Guarini, the runner-up from last year's American Idol, couldn't even come close with his lame version!


There's been rampant speculation about what Clay will sing for the final show. Some say 4 songs, some 5, some 2. A few guess Clay and Ruben will have to sing one common song, others say it'll be an original composition specially written for them, etc. The possibilities are endless. I just hope Clay will be allowed to make his own song choices, and that he will pick one fast, catchy number, followed by one that showcases his amazing power and range. And he should wink at the camera, just once -- that'll be the icing on the cake, and propel him to victory for sure.

Good luck, Clay!

It's a Sunday call, and so far so good.
I've been spending quite a bit of time on the Internet recently, due to the upcoming American Idol 2 finals, which feature Ruben Studdard and yes! Clay Aiken! After his dynamite performances in the last round, he's now in the top 2 for this extremely tough competition, and I couldn't be happier for him!

One of my favourite websites is definitely www.claytonaiken.com, for its terrific downloads and pictures, not to mention great links to articles, and my latest addiction, the chat room. It's been very active lately, as you can imagine, and I had a fantastic time hanging out with fellow Clay fans these couple of days -- though it's wreaking havoc with my eyesight, and I should be studying, darn it!

But never mind that. The reason I'm writing is because I actually bumped into 2 people on the chat, that I just absolutely have to mention. One is a good friend of Clay's, who drops by regularly, and who is well-known by all the other users who frequent the room. The other is an awesome lady named Robin, who believe it or not, came across my post in the forum a few weeks ago -- I wrote about how big a fan I am, how Clay has loads of supporters in Singapore, and how he has a positive effect on me and so many others here. Robin took the initiative to forward my post -- without my knowledge -- to one of Clay's best friends, who confirms that Clay got it and read it!!! Wow, I am in shock right now, but recovering slowly... Bet you can tell I've got a big smile on my face though, haha. :D It's just amazing how the Internet can make anything possible, but it's really nice people like Robin who help you realize your dream. Thank you so much, Robin!

And Clay, if you happen to find time in your busy schedule to actually drop by my blog, we're all praying for you to win!

We're now 100% sure the fever incident at the IMH was caused by influenza. The countdown to being declared SARS-free is on. It may be as soon as today. Keep your eyes and ears peeled for that announcement. Yay!

Not too sure if there'll be a shift in the number and types of cases we see at the ER. In my opinion, the system has been and always will be abused. But I think this episode has changed the public's perception of healthcare workers, and hopefully we won't be seeing any complaint letters for a long time. Sure, they'll resurface sometime in the future, but the next time I see a frivolous complaint coming, I'm going to... well, I won't say it here. ;)

This marks the beginning of the end of my reporting on the SARS situation in Singapore. It's been a great experience sharing with the rest of the world, and I thank all you readers, as well as people like Tim Bishop, Phil Ingram, Nina Thorsen and Alexandre Levy, who helped publicize the site, and of course, The Guardian and MSNBC, who embraced the blog in such a wonderful manner.

It'll be nice to get back to normal soon. The ER should be quite interesting, so I'll concentrate on that next month. :)

Here's a link to an article in the British Medical Journal, written by a paediatric cardiologist currently based in NUH. I got this off The Guardian's website.

I had a feeling about the IMH scare, and it looks like it may turn out to be right. The authorities are "99% sure" that it isn't SARS, and final confirmation may come as quickly as this afternoon, followed by the possibility of Singapore being taken off the WHO's list of SARS-affected countries by tomorrow. If this does come about, it will mark the end of a physically and emotionally draining saga for all of us here. But let's not lose track of the dangers of complacency. As I mentioned before ( read The Phantom Menace: Lessons Learnt From The SARS Outbreak In Singapore ), there have been marked changes in the ways we practise medicine, and these changes will continue, perhaps indefinitely.

I spotted a book on SARS in a store a few days ago, written by a few doctors from Hong Kong or Taiwan, if I remember correctly. It was mostly technical stuff, with little perspective on a more human scale, so to speak. It would be good if someone could write about SARS from that angle, and get the inside stories from healthcare workers, patients and others who have been significantly affected by the disease. I, for one, would buy such a book if it ever got published.

Updates on Singapore's SARS status will be available tomorrow. I'll post again after I get the news.

Looks like the fever at the IMH is caused by influenza, rather than SARS. Fantastic news! Not just because this brings Singapore closer to being declared SARS-free by the WHO, but also because the chance of our postings being extended yet again will decrease. Yay! ( No offence to the department I'm currently in, but with my MRCS (A&E) Part 2 coming up in August, I need to get to the A&E Department as soon as possible, or I don't think I'll pass! )

Yesterday, while at the neighbourhood wet market with my parents, I saw a man in his 30s sneeze onto a whole pile of fish. I gave him a really long, hard stare, but he was oblivious. Some people are just terrible, I tell you.

Wore the space suit for the first time on Wednesday night when I intubated a patient with sepsis and metabolic acidosis in the ICU. I must say it conveyed a wonderful sense of security for me, since my N95 mask has a tendency to leak when I look down or move my head too much. And don't even think about laughing or smiling with that thing on -- your glasses will fog right up and scare the wits out of you.

The only problem with the suit is the inability to hear anything besides the whooshing of air as it passes your ears during the generation of positive air pressure within the head-piece. The nurse assisting me was also wearing one, so we were practically yelling at each other during the procedure -- "3mg of Dormicum!", "What?!", "I said, Dormicum!!", "Huh?", "Oh, never mind, here it is."
One way of getting past this is to press on the sides of the head-piece to stop the airflow temporarily. In any case, it was a novel experience. :)

Before I end off, let me relate a conversation I overheard on Class 95 this morning. The radio DJs asked its listeners to guess the answer to the question: The average person has 120 of these. One smart fellow, named Brian, said "vocal cords". I used up quite a few tissues after hearing that one! In fact, I'm still laughing now. :D

As the title of one of Clay's previous chosen songs says, "I Can't Help Myself"!

Spoilers ahead if you live outside the U.S. Proceed with caution.

Clay fans, here's a huge treat for you -- the latest video clips of his performances are up, click here for a look.

He started off with Vincent ( Starry, Starry Night ), by Don McLean, which I thought was pretty good, but which the judges unanimously dissed, 'cos they found it "dreary", and ack! Clay forgot some of the lyrics ( nervous, I'm sure ). For me, this song forever belongs to Josh Groban, whose cover version is the best so far. Still, Clay's wonderful voice shone through.

Next, he redeemed himself well with Mack The Knife, a fast jazzy number that's been done by all the great old-timers, plus more recently, Robbie Williams. Clay nailed this one right on the head, and had "superstar" written all over him during the number. The judges loved it too, with Simon Cowell telling him that he "just pulled it out of the hat" and that it was "brilliant" and "amazing". Woohoo!

Last, he gave the performance of his life with Unchained Melody. I already suspected he'd sing this, 'cos in one of his early interviews, he mentioned this as his favourite song. My opinion? I'll say this only once, with a red face, haha :) : I have such a big crush on Clay Aiken right now! Okay, got it out of my system. ;)

Results will probably be out late tomorrow afternoon. I'm post-call, so I may log on to find out before the show starts. Wish I could contribute to the voting process, but the phone bills would bankrupt me, so...

Many congratulations for your terrific performances, Clay! I'm sure you'll get through to the final 2!

P.S. Here's a nice article from The Charlotte Observer, about Clay and his pals Ruben and Kimberly. They may not show that much mutual affection on-screen, but in real life, theirs is a friendship that is likely to last a lifetime.

This morning's headlines were rather alarming. A significant number of patients and ward staff at the Institute of Mental Health (IMH)are down with fever. As a precaution, over a thousand inmates and healthcare workers have been mass transferred to alternative quarantine areas, with the remainder quarantined within the hospital premises till further notice.

Investigations are still ongoing, as one of the first cases is a long-stayer who had no exposure with respect to SARS, and I guess people are scratching their heads saying, "What the...?"

It might have seemed like huge news, but putting this on the front page was just a tad premature. No doubt it would've frightened a lot of Singaporeans. Plus, the IMH, located at Buangkok Green, is situated right smack in the middle of a residential community.

I don't know anyone who works there, so if any IMH staff drop by, a brief update would be welcomed.
Personally speaking, I prefer to wait and see before crying wolf. In the meantime, I hope the psychiatric ward here won't get swamped. We're already overworked!

I've got some time before the busy day starts, and just want to post my thoughts on a frivolous pursuit of mine: Survivor: The Amazon. :)

After months of drama and speculation, the 6th installment came to a close Sunday night in the U.S., with its final episode airing locally yesterday. So yes, I knew the result before I watched the finale, and was shocked beyond belief. Jenna?!?! Is there no justice in the world anymore?!

I don't know about other fans of the show, but I rooted for only 2 people to win -- Dave Johnson the rocket scientist ( who proved too big a threat and was voted off early ) and Rob Cesternino , a computer projects co-ordinator ( or something like that ), who is the best Survivor player I have ever seen in this long-running series, which is saying a lot.

So how did Jenna the lazy bum snatch the crown from devious Rob? Simple -- by winning the last 2 all-important immunity challenges, and smartly picking Matthew the psycho to go with her to the final 2, leaving Rob ( the obvious pick to win ) out in the cold.

Though it wasn't the outcome I'd hoped for, Surivor: The Amazon was a great rollercoaster ride for me, and I suppose, in that aspect, the result shouldn't be that surprising after all. My other favourite moments include (1) the much-talked-about reward challenge, where Jenna and Heidi stripped naked for some peanut butter and chocolate, (2) the first reward challenge, which pitted the guys against the gals, and which the men lost, because young beefcakes Ryan and Dan couldn't make it across a wooden pole, and (3) Shawna's amazing turnaround from depressed whiner to perky flirt when the tribe members were switched midway through the competition, and 3 of the men moved over to the women's camp. Never thought testosterone was such an effective mood-lifter. :)

But seriously, this game would be nothing without the scheming Rob, who made so many false alliances and backstabbed so many unsuspecting "friends" he made my head spin. He was the main reason I enjoyed the show, and would definitely have won if he'd made it to the final two. His coup de grace would have to be the time he double-crossed Alex, Heidi and Jenna by ganging up against Alex with the other tribe members, then actually managing to win back the girls' trust, form a new alliance, and vote Christy out. Wow, I bow down to you, Rob. You are my guru. :)

Call it what you want: a twist of fate, just plain fantastic luck, or maybe, just maybe, Jenna's been acting useless all along, only to show her true strength when it mattered most. Whatever the reason, she's the youngest winner of Survivor at the tender age of 21, with US 1 million moolahs in her pocket. And with her mom undergoing cancer treatment, she could really use the money. Congratulations to her for overcoming tremendous odds.


I stayed up to watch the reunion special last night, and it was actually pretty exciting! I got to see all the contestants in their cleanshaven, dressed-up and made-up forms, and let me tell you, Matthew, Rob and Alex are way cuter than Ryan and Dave. Rob, in particular, even made my mother sit up -- after looking grungy for 1 1/2 months out in the wild, he transformed into a pretty good-looking fellow once his horrible beard was removed. And although he was the least lucky with the ladies in the jungle, he told host Jeff Probst that after finishing his stint on Survivor, he now has a girlfriend, but the bad news is, she doesn't believe anything he says (in reference to his lying tendencies on the show, no doubt ). What a comedian. :)

And speaking of Jeff Probst, he looked fabulous in his denim shirt and white pants, with a great tan and toned muscles. Sorry, I'm only human. ;) And I totally agree with his comment that Rob is "the best Survivor player to never win." I think he'd be perfect for any job that requires deal-making and corporate takeovers, but after something as high-profile as Survivor, people would never be able to trust him, so his talents would be wasted in that area. Sigh.

Up next, Survivor: Pearl Islands, off the coast of Panama. I can't wait!

The Phantom Menace: Lessons Learnt From The SARS Outbreak In Singapore

Like many of my fellow colleagues, I never imagined that I would ever witness an epidemic of such proportions in my lifetime. Sure, we’ve all read about The Black Death, the Spanish / Asian / swine / avian flus, which claimed tens of millions of lives over the past century or so, but no disease in recent years has hit this close to home, or caused as much morbidity and mortality locally in such a short period, as the Severe Acute Respiratory Syndrome ( SARS ).

The months of March and April 2003 will be etched in our minds forever, but let’s not forget some important learning points we can garner from this historic event.


Lesson 1: Microbes shall inherit the earth

The first lesson I learnt from this is how helpless and fragile humans really are. Despite unbelievable medical advances in the past few decades, despite the development of new and powerful antibiotics, despite improvements in living conditions and lifespans, we are still defenceless against something so small it can only be seen under an electron microscope.

The culprit, a new breed of coronavirus, is capable of striking anyone, from young children to the elderly, but also displays a disturbing ability to kill strong healthy adults. No effective treatment is available at the moment, and the anti-viral agent Ribavirin shows inconclusive results and is associated with a whole slew of potential complications, while possible serums and vaccines are still undergoing clinical trials.

It is a humbling fact. We may be at the top of the food chain, but in truth, we all live by the micro-organisms’ rules.


Lesson 2: The world is one giant microbiological melting pot

Overcrowding, poor sanitation, malnutrition, war – those were the original catalysts for some of the worst global pandemics. But urbanization has brought its own dangers, as deforestation and expansion of living communities disrupt the natural order of the ecosystem and expose our virginal immune systems to a multitude of new pathogens. HIV and the Ebola virus are postulated to have jumped species in this manner, while the coronavirus, like its porcine and avian counterparts, probably skipped over to humans through the process of domestication and farming.

Now, in the 21st century, air travel can work for and against us – providing invaluable assistance in the transport of medical supplies and expertise to affected areas, but also helping to spread diseases across entire continents. A relaxing vacation can turn into a nightmare, as evidenced by 2 of Singapore’s index cases, who contracted SARS during a holiday in Hong Kong, where they stayed at the now infamous Metropole Hotel, and caught the illness from another hotel guest -- a Chinese doctor who earlier treated a SARS patient in his country.

Conditions are unlikely to change. If anything, they will only continue to progress in the same direction. And considering how microbes possess a built-in mechanism of constant mutation, we could say that the world is their stage, and we humans, mere players.


Lesson 3: Rising to the occasion

This crisis tested the characters of all Singaporeans, but none were as scrutinized as those on the frontlines of the battle – ie. the healthcare workers – and I am extremely proud to say that our medical community is one fearless bunch. Over at the CDC and Tan Tock Seng Hospital (TTSH), which to this day continue to receive any new suspect SARS cases, doctors and nurses work tirelessly, with some even volunteering to cover SARS wards and intensive care units.

The large surge in patient numbers resulted in manpower shortage, and medical officers in particular, were shunted from other departments to help care for SARS patients. Predictably, a few blanched at the idea and even refused to accept their new duties. However, most soldiered on, overcoming their anxiety and fulfilling their Hippocratic oaths.

In all other government hospitals, special fever wards were set up, and small teams of doctors and nurses assigned to man them. Although I passed when I was approached ( in deference to my worried parents ), I know of many who agreed without any hesitation whatsoever. A number of them are married with children, and admitted that their greatest fears were either infecting their families, or dying from SARS themselves. But in the end, their sense of duty to their patients and the medical profession emerged the victor.

It has been a great inspiration to the rest of us, and these heroes and heroines also showed the world what our healthcare workers are made of. We salute you all!


Lesson 4: The dark side of human nature

It is said that crazy times can drive people to do crazy things, and this was illustrated perfectly by some of the jaw-dropping antics of certain Singaporeans in desperate need of psychotherapy.

My favourite is the middle-aged man who repeatedly flouted home quarantine orders, then went out to a Queen Street eatery one night, and blatantly bragged about his law-breaking behaviour.

Another man, who recently returned from China with a fever, gave new meaning to the term “in denial”, by escaping from TTSH’s A&E department after being forcibly sent there straight from the airport. He was later put on home quarantine and cleared of SARS, but his lack of social responsibility was frightening, and may have resulted in disaster if he had contracted the disease.

And let’s not forget how healthcare workers, especially nurses, were ostracized by unenlightened members of the public. Bus-drivers refused to stop for them, passengers avoided them, beauty parlours wouldn’t give them appointments, and landlords threatened to evict them. Doctors didn’t suffer such degradation, probably because we don’t wear uniforms. But I found myself withholding information about my job, and fretted about possible repercussions when using my credit card, which bears the Singapore Medical Association’s logo. Luckily, the few times my profession was discovered, I was treated with respect, and even thanked by a few appreciative people. And due credit should be given to the many organizations and individuals who made the effort to pay tributes and donate generously to the Courage Fund.


Lesson 5: The death toll

Like any other outbreak, SARS claimed its fair share of human lives all over the world. However, Singaporeans bore witness to tragedies which, though small in number, proved a heavy burden to bear.

One index case, a woman in her 20s, lost both her parents and her church pastor to the disease, while she survived. Many others cross-infected their loved ones, and some were unable to be at their relatives’ bedsides when they passed on, due to strict isolation guidelines.

But from the medical community’s perspective, the loss of 2 of our fine, young doctors caused the most anguish, as evidenced by the eulogies in this month’s SMA News, and the many outpourings of grief from those who knew them both. They were bright yet humble, with happy families and so many things to look forward to, but their lives came to untimely ends, cut short by an undiscriminating and unforgiving disease.


Lesson 6: The media

Regular readers of my blog are well-acquainted with my complaints regarding the local press’ handling of an already sensitive situation. A short recap would include the unnecessary revelation of the “super-infector’s” name ( not to mention the indelicate label itself ), some puzzling columns that served to glorify reporters rather than the medical workers, plus a rather mean description of an inquiry involving a local infectious diseases specialist who boarded a flight from New York despite being unwell and having been in contact with a SARS patient prior to falling sick.

Subsequently, they came to their senses, and started doing some good features on staff working at TTSH. They’ve also kept the entire nation well-updated with all the facts and figures, and helped in the process of contact tracing by highlighting new hotspots ( e.g. the Pasir Panjang wholesale market ).

Sure, there were a few hiccups in the beginning, but I hope the local media will learn from their mistakes, and avoid making them again in the future.


Lesson 7:The authorities

The government pulled out all the stops, which accounts for its effectiveness in curbing the spread of SARS in the community. From shutting down schools and enforcing home quarantines, to mass transfer of affected wards and disallowing visitors to hospitals, our ministers took their tasks very seriously, and the results have been no less than astonishing, considering the fact that 5 million people currently populate this tiny little island.

Protective gear was also generously provided, and I never had any trouble getting N95 masks, gloves or space suits whenever their use was required. Contrast this with countries like China, where doctors were denied even simple surgical masks, and you’ll be glad you live in Singapore.


Lesson 8: Keeping the faith

This is a small bit about my Christian beliefs, so if you’re squeamish, you can skip this part.

Some of you may remember that I was only recently baptized, after 15 long years of contemplation and indecision. But contrary to many non-believers’ opinions, being Christian doesn’t guarantee a cushy life, and yes, sometimes even the most mature Christian questions his faith in the face of immeasurable tragedy.

Ponder this: The 2 doctors who perished from SARS were both devout Christians, and so were their loved ones. One of these doctors was engaged to be married in September, yet his fiancée remains steadfast, and even says, “I do not question why God took you away.”

Many of you may find it difficult to comprehend, but having previously been tested myself, as well as having a close friend who also grappled with his faith after his father’s death earlier this year, I recommend Philip Yancey’s excellent book, titled “Where Is God When It Hurts?” to anyone who yearns for answers to these important questions. Any comments are most welcome.


Lesson 9: Band of brothers ( and sisters )

If anything, this epidemic has only made our nation stronger. Besides equipping us with the skills and knowledge to face further similar situations, a few of our ministers ( who are doctors themselves ) took the extra step of donning masks and visiting affected hospitals to assess the situation in person. The public, hopefully, now realizes the vital role it has to play in the prevention of further outbreaks, and will continue to comply with implemented guidelines, and show some social responsibility should the need arise.


Lesson 10: A close shave – changes in the way we practise medicine

As an emergency medicine trainee, I recall my first posting in the ER in 2001, where I saw hundreds of patients with a wide variety of complaints, including fever and respiratory symptoms. At the time, in the pre-SARS era, we attended to all these people without any form of protection. And when intubating during resuscitations, we wore surgical masks ( with or without shields) most of the time.

In February this year, during a call covering the MICU, I took care of a 21-year-old female with fulminant pneumonia. She was critically ill upon admission, requiring mechanical ventilation, and had just returned from a mission trip to Indonesia. She collapsed later that night, and when I ran into her room to resuscitate her, I did not wear a mask. Neither did a few of the other nurses who assisted me.

You can thus understand why these events came to mind when SARS reared its ugly head in Singapore. In hindsight, I shudder to think what would’ve happened if that 21-year-old girl had been the index case. ( She turned out to have community-acquired bacterial pneumonia, albeit in its most severe form. )

So although we haven’t had any new infections for almost 2 weeks now, there will be a major change in medical practices, both here and globally. There is just no way of telling if and when the next wave will hit. We just have to be prepared at all costs.


What’s next?

Your guess is as good as mine! But I will tell you this: SARS is not the last epidemic we will ever see, and it definitely won’t be the last of the new pathogens to hit the unsuspecting human race. When and where the next outbreak will originate remains the $64,000 question, but as Pete Davies said so ominously in his article, “The Cycle of Death”, “Once again, we (will) find ourselves at the mercy of nature.”

I'm sure you would've noticed a slight decrease in the frequency of my posts, but that's good news, 'cos as of this morning, Singapore has had no new SARS cases for at least 10 days. Yeah! :)

However, the past month will no doubt go down in local history, and has definitely made an indelible mark in the lives of all Singaporeans, especially those in the medical sector. Some may just view this as a passing storm, but I for one have learnt many valuable lessons from this once-in-a-lifetime experience, and will be writing on this soon.

Over in the outpatient clinics, the number of cases has returned to normal -- ie. too many to count. But the temperature-monitoring and filling of health questionnaires still proceeds, though the accuracy of the latter measure may not be foolproof. For example, my parents recently visited another hospital during a medical appointment, and when an elderly man was presented with the form, he looked really confused, and nobody was free to explain it to him. So in the end, he stood next to another man and copied his answers wholesale!

And with deference to the powers that be, I have edited my blog entries ( especially those since late March ). Yes, it was bound to happen sooner or later, but I'm just glad I was merely asked to be a little more discreet, rather than forced to remove the website entirely. I guess I could've averted this by being anonymous from the very start, but darn, my ego prevented that. :)

The fever's gone, just as I predicted. Good news for those in the wards, since I'm on call, and able to help with the clinics for the whole day. :)

I made the right choice in changing duties, and believe it or not, clinics are good right now when compared to the chaotic situations in the wards, with the new housemen and all. I haven't been around during the changeover since 2001, when I did gastro in SGH, but even then, I did mainly passive calls, and had perhaps 1 or 2 active calls at the most, and the ward I covered had only 5 or 6 gastro patients in total, so I wasn't really affected overall.

Nice to hear from you, Daryn. Though it's sad that this is the only way I can communicate with you guys! Identify yourself to me one of these days if we meet in the canteen. :)

Not much to update about the SARS problem here, but I consider that a good thing. After some heavy duty blogging a couple of weeks back, I like to be able to talk about idle stuff for a change, like Clay Aiken! ( Those of you who can't stand my drooling can stop reading right... now! )
Yes, I visited the American Idol website, and here're the songs Clay sang ( the theme is Bee Gees songs ) -- "To Love Somebody" and "Grease". I know both pieces well, and can already imagine what they sound like with Clay at the helm. Good choices! The video clips aren't ready yet, but check again tomorrow and you can bet they'll be there. Great site, this one.

It's 9pm, and can't say I'm complaining. Hope the MICU remains quiet, and that the A&E department keeps the admissions to a minimum. I'm contemplating watching "The Bachelor 2" on one of the upper floors even. But mustn't get greedy, 'cos this sort of thing usually doesn't happen on my calls. ;)

I notice there haven't been any comments on the SMA News. Has anyone read it? I found Prof. Low's eulogy for Dr. Alex Chao very touching. This is probably the first time any of us have had to read so many eulogies in one single issue. And with 2 of them related to SARS, it certainly makes things more painful.

Okay then, it's off to the evening ICU round. To everyone else on call with me in medicine tonight, have a good one!

Looks like I spoke too soon. I didn't make it to work on Monday after all, due to a splitting headache that made me feel as if a whole tribe of Ewoks was banging the bongo drums in my skull. And after returning to the hospital this morning, I was found to have a low-grade fever and given another day of medical leave. I'm completely asymptomatic otherwise, but with current policies on keeping febrile healthcare workers at home, I don't have much of a choice. But I'm pretty confident my temperature will return to normal tomorrow -- I'm on call, so it had better return to normal!

I've also asked to be diverted away from the wards, and will be running the specialist clinic full-time till the end of the month. The stress finally got to me, and with my mysterious fever, you could say I'm burning up 'cos I'm burnt out, haha. :)

So here I am, sitting at home on a Tuesday afternoon, spending some time blogging, plus downloading from Clay's website again. For my fellow Clay fans out there, there've been some fantastic additions to the video/audio clips section, including one of his Atlanta audition, where he looked really nerdy but totally blew the judges away with his amazing voice ( congrats to Simon and Randy for picking him based on talent instead of looks ). There's also an alternative version to "Somewhere Out There" under the "Halfway Home" special, that is sung to perfection. It's just really interesting to watch Clay's transformation, in terms of appearance and showmanship. He has definitely come a long way, and judging from last week's votes, there's a high chance Clay Aiken will be the next American Idol.

Due to my change in work duties, I have yet to set eyes on my new housemen. I hope you guys are doing okay upstairs, and my apologies for bowing out at the last minute. I did, however, meet another young chap at the lift this morning. He did an attachment with us during his final year, and mentioned that he reads my blog. Wow, I'm still overwhelmed whenever anyone I meet talks about my website, so thanks. :)

Drinking lots of water, so hopefully this'll keep my temperature at or below 37 degrees Celsius. Till next time then.

Last but not least, here's the link to this month's SMA News, which is finally out online. Please read, and keep your comments coming.

Sorry I didn't post for a couple of days. Friday was awful -- but that's putting it very nicely -- and Saturday wasn't any better. Our housemen were caught up with orientation programmes lasting the entire day, leaving us medical officers in the overcrowded wards to do everything from rounds to paperwork, updating relatives, handling collapses, and yes! blood-taking! I had 40 ladies on my hands, and due to some shuffling of ward teams which give mes epigastric pain when I think about it, I didn't eat lunch till after 3pm on my post-call afternoon ( but at least I got to leave the hospital by 2:30pm ), and crawled home only at 2pm on Saturday ( when most had probably gone by 1pm ). My deepest gratitude to the new registrar ( aka senior resident ) who helped me take blood yesterday when I told him I couldn't stand it anymore, and my fellow resident ( who was my intern just a few days ago ) for bravely doing rounds without me today ( hope the spanking new housemen are enthusiastic! ). Anyway, I spent my weekend sleeping, and feel a bit more refreshed to start the new week tomorrow. :)

Here're a couple of interesting emails I'd like to share. The first is from my old friend, while the second is written by a houseman who just entered the working force on Friday. Enjoy.


From my old pal:
Kudos to your blogsite. And thanks for your effort to update everyone in these uncertain times. Call it voyeuristic if you may, but it sure makes for good reading material, when you're in hospital and not supposed to walk around too much and mix with people.

We now do rounds with full ID protection ie. goggles, mask, gowns, gloves. That day, I was made to wear a slogan sticker of sorts on my baju ( Malay term for scrubs ) that says " wear your masks, they save your lives" or something to that effect, 'cos my name wasn't in the list that contained people who have attended the mask-fitting sessions. No visitors are allowed and that means updating by phone for the relatives. Feels a bit funny when you call them up and attempt to "update" them about some old guy who has been around for a while and for some obscure reason is still in hospital but is otherwise as stable as a rock. But I do appreciate it to a certain extent, 'cos you dun have to face difficult relatives face to face, and you don't see a whole kampung having a picnic in hospital anymore.

My exams in June are cancelled if you haven't already heard, and the UK only allows us to go up if you can afford to stay out of Singapore for 3 weeks before you take the exam. Can't afford the leave ( don't know if we'll even change over), and the summer lodging prices in UK are steep. Hence, I have to defer my attempt till October or November.

I pray that everyone I know, including you, will stay afebrile. Take care."


From the new houseman:

"So far so good as a new HO. No big scoldings and no major mistakes as yet. But it's still too early to tell as this is ONLY Day 2 of our medical career. One thing's for sure though (and it's a shared sentiment) -- we are blur about everything, work is overwhelming and how on EARTH do you senior people remember the dosages and timing of the medications? I for one am rather bad at numbers and I can foresee myself asking my MO many times in the future " Err, what's the dose huh?" I have not given my first IV bolus medication, so there is this anxiety about giving my first concoction. As medical students, we have all heard about a disastrous incident involving some doc giving an IV potassium bolus by mistake with dire consequences. I guess all this adds to the obsessive-compulsive behaviour of checking and re-checking meds to be given via IV.

Most of the new HOs have been fitted with the N95 masks and underwent some form of PPE test before we were set loose into the wards. That transient fitting session of the mask did little to warn us of what is ahead.

My first day was a rather err... sticky experience. Humid weather, sweat gluing the gown to your skin ( thank goodness we ordered some baju for the day) and the N95 mask acting as a sort of condensation device. You can feel the droplets forming as the hot morning hours sizzle by whilst you patiently stand and wait for your consultant/registrar to give their orders. The mask really left an impression on me, or my face rather! Yes, it's full armour into the wards, goggles and all, and I do appreciate that all this is necessary for this current SARS war. But there are always moments in which I really felt like tearing the mask away from my face and allowing the skin/nose underneath it to breathe properly. It really calls for tolerance. Must "ren"!

I must say the nurses and other staff in the wards were quite helpful and rather obliging in answering trivial questions ranging from how to fill in blood forms, making a community hospital referral and other nitty gritty stuff. I am covering the overflows in my ward and more than half the time, I'm by myself attempting to do changes as my MO/senior HO is in the ward helping the other HOs. But thank goodness the nurses are around and the occassional God-sent MO comes to help out with things. And yes, the phlebotomists! - great people aren't they?

The day ended at around 7.30 pm, which was a relief to me. My ward colleague had mentioned to me earlier in the morning that he couldn't wait to get back home in the evening. I was surprised, not by his remark, but because I hadn't given thought to it and was expecting for the day to end late into the night. I was all prepared to go through an arduously hot day and for the sun not to set. Thankfully, the sun DID set and my tasks were finally completed. It was with a light foot and a light heart that I stepped out of the hospital... and discarded the N95 mask into the nearest dustbin!"


SARS In Singapore
Well, the Sunday Times gave a rather optimistic picture about the SARS situation in Singapore. Seems hospital-acquired infections are being curtailed effectively, though community cases are still springing up here and there. We're all praying for the epidemic to abate, and although Grace from NYC's kind words are most comforting ( it is available in the comments section for May 1st ), I don't think any event in this generation can compare to the tragedy that was 9/11. I can still remember exactly where I was and what I was doing the night the terrible news broke -- the ER of SGH, during an afternoon shift. Our senior resident called us into the staff pantry to watch CNN, and as we stared in horror at the burning World Trade Centre tower, we got another jolt when we saw a second plane crash into the other tower. It was an act of pure evil of unimaginable proportions, and although I wish I didn't have to witness something as painful as this in my lifetime, what happened after the attacks demonstrated the amazing ability of the human race to survive.

I guess, with the advent of this new disease we now know as SARS, humans are called upon again to draw strength from each other and fight back. I have no idea when or if we'll ever win this war, but as Bill Pullman said in the film "Independence Day", "We will not go quietly into the night." And that's all that matters.

Hmm, 10:30pm, is it safe to say we're out of the woods yet? Better not jinx myself. :) But hey, I got to watch American Idol in its entirety while on call! A medical call! That alone makes me soar to cloud nine, but wait, does anyone agree it was an excellent episode?

In case you're wondering where the TV was located, well, with visitors being barred from the hospital, we picked a nice quiet spot in a waiting area on one of the uppermost floors, and thankfully, our housemen didn't page us for the 2 hours our eyes were glued to the goggle box.

This is by far the best show -- my previous favourite was the disco edition. The bonus, of course, was getting to hear Clay sing twice instead of just the usual once, and he did so well! Congratulations! His rendition of "Build Me Up Buttercup" was fantastic, and "Solitaire" wasn't bad either ( though I think he overdid the trills a bit ). Neil Sedaka, whose music I've loved since I was a toddler, paid Clay a great tribute when he said he'd "kill" to produce his debut CD. A Clay Aiken / Neil Sedaka collaboration? It's a surefire hit!

The biggest upset though, was how Josh Gracin, who really mauled his 2 songs, wasn't voted out, while Trenyce and Ruben were kicked down to the lowest 2 positions. Ruben the Unbeatable, can you imagine?! Simon Cowell was so mad he just kept shaking his head, and for once, I agree with him. I have no idea what the voters were thinking. It's like Carmen all over again -- that girl can't sing for nuts, but made it to the final six! Let's hope this won't happen again. And Clay, I'm still rooting for ya!

May Day call. So far so good ( yes, yes, touch wood! ) :)

This site has been linked again, this time to MSNBC. . Their review is pretty interesting, especially the part about my blog sounding like a war correspondent's report!

With the new housemen joining us tomorrow, here's wishing you good luck! The situation where I work isn't anywhere as scary as that at Tan Tock Seng, of course, but we all know that SARS can pop up when and where you least expect it, so be careful. And speaking of being careful, here're a few tips for you newbies:

1. If you're working in a non-air-conditioned ward, be sure to wear comfortable, not-too-thick clothes. With the masks, gowns and gloves we don, rounds can be a real nightmare if you become dehydrated.

2. Don't be complacent. You may be tempted to skip certain protective steps during the rush of ward work, but after my close brush with a SARS patient about a month ago, I've learnt that no patient is considered SARS-free, and it's better to be safe than sorry.

3. Make sure your N95 mask is of the correct size, and that you learn how to test it for leaks. There are specialized staff to help you with this. Don't treat it lightly, 'cos it will save your life.

4. Be responsible when discarding used protective gear. It should be thrown into special biohazard bins -- these have big yellow signs on them -- NOT the usual wastebaskets. And if you want to carry your masks around the hospital, put them in a sealed plastic bag ( which you can get from the office here at CGH ) instead of swinging them around when you walk.

5. Whenever you clerk a new case, the first thing you have to establish is whether the patient has any risk of exposure to SARS. Be detailed, no matter how painstaking and time-consuming it may be. We are living in different times now, and our first priority isn't to get the correct diagnosis, it's to answer the question: "Does this person have SARS or not?" Things to cover would therefore include:

a) travel to SARS-affected countries
b) visits to local hotspots, ie. all the hospitals, certain nursing homes, the Pasir Panjang market; and don't forget high-risk areas like Changi Airport.
c) contact with SARS patients / SARS contacts
d) whether the patient's family members are currently on home quarantine

Of course, direct questioning doesn't guarantee total honesty, so if the patient or his accompanying relative decide to lie, he or she could still slip through the net. That's precisely why strict protective measure are so important.


I'm rather sad that I'm on call the night American Idol is on, but at least my timer will help me get it down on tape. :) Clay Aiken, my favourite, will be singing "Build Me Up Buttercup" and "Solitaire", with the theme being "The Sixties / Neil Sedaka" -- really cool theme, by the way. :)

Well, I'm looking forward to meeting my new housemen tomorrow. Have a good rest today, and I'm gonna sign off and do some reading.