FRE
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February/March 2013
HealthNews Inspiring and informative stories for patients
MCI (P) 040/01/2013
Running to victory I
t was a balmy morning and there was a bad crush outside the Esplanade. ‘Bad’ here was actually good, as 15,000 women of all ages were gathered at the starting point of the Great Eastern Women’s (GE) Run, a popular annual event. Among them – My Linh, 16, and a Singapore Chinese Girls’ School (SCGS) Stories of student, leaning on a crutch. It was a five-kilometre run – but My Linh’s teachers, parents and fellow students had been very positive. “You needn’t run,” her teachers had advised before the sign-up. “Set your own pace.” “Slow or fast, you’ll get to your goal,” her dad said, giving the thumbs up. “We’ll be with you,” her friends affirmed. My Linh did not have the opportunity to consult with her oncologist, Dr Ang Peng Tiam, nor Dr Khong Kok Sun, the orthopaedic surgeon who cared for her leg. “But I know how they’d respond. They’d just say ‘Go for it!’” My Linh smiled.
HOPE
And so she did. Thus, on 11 November 2012, she completed the GE Run in a time of one hour and 24 minutes. “I felt great. It was my first ever race! At the end of the race, I didn’t feel tired at all. I just treated it as a walk. And there were lots of people finishing after me!” Did she do anything special to prepare herself for the Run? My Linh laughed apologetically. “When we were invited to sign up in September, I had set a resolution to be more active, to challenge myself. But I didn’t do any special preparation, I simply swam laps at home and walked around the track during school P.E. lessons.” My Linh garnered special attention in the Straits Times, dated 10 November 2012. It was not just because this soft spoken student was tackling the run on crutches. It was because she is a cancer survivor – an inspiration to all. Continued next page
Cancer in her right leg didn’t stop My Linh from completing the race of her life
My Linh with her parents, standing proud after she completed the Great Eastern Women’s Run.
IN THIS ISSUE: A meaningful job | 奔向胜利 | PCC terus berkarya dan memberikan yang terbaik
Stories of Hope
From cover page
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at www.facebook.com/ parkwaycancercentre Editorial team Pauline Loh Vincent Tan Xavier Tan Publisher Preston Communications Printer Impress Printing No portion of this magazine may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, re-sold, redistributed, in any form or by any means without the prior written permission o f t h e p u b l i s h e r. Information provided in this magazine is not intended to replace the advice of your health professional.
She was diagnosed with osteosarcoma, or cancer of the thighbone, in her right leg at the tender age of nine. In Vietnam then, the only answer for bone cancer was amputation. But that was not an option for My Linh’s parents. They searched high and low and were even prepared to go as far away as the USA for treatment, but they found a good alternative in Singapore. “When I came to Singapore, my first question to Dr Ang was whether my daughter needed to have her leg cut, so I was very happy when Dr Ang said she could keep her leg,” My Linh’s mother recalled. It was like a sign to the family to place their confidence in Parkway Cancer Centre. My Linh started seven rounds of chemotherapy in November 2006. Meanwhile, the medical team scrambled to find a suitable bone transplant. Dr Ang explained the process, “Instead of surgery, we offer such patients chemotherapy first. By doing so, number one, we’re able to determine whether this cancer is responsive to chemotherapy, or not. If the tumour is responsive to chemotherapy, not only are we controlling the cancer in the bone, but we are also treating the micro-metastases, which we cannot detect through scanning.” “Number two, we are buying ourselves time – to prepare a suitable bone transplant or prosthesis, so that when we finally do the surgery, we’re able to replace the area in which the tumour is resected.” The tumour taken from My Linh’s leg was sent to the pathologist and the cheerful results were that chemotherapy had been effective. An allograft bone was inserted which successfully bridged the gap in the bone. My Linh blithely disclosed that she had been through seven operations so far. And there’s a possibility of more in the future. “General anaesthesia? Pain after surgery?” she shrugged at those nightmares that have made adults turn pale with fear. “Maybe because I started having surgery when I was still young, so I’m not so afraid of it.” The important thing was that she kept her leg. The crutch is for additional support. In every other aspect, My Linh is like any 16-year-old girl. Moreover, she is a scholar in one of Singapore’s premier girls’ schools. She loves her CCA, Girls’ Brigade, and chatters animatedly about earning badges for goals like cooking for the elderly and helping out at home. Does she ever blame the cancer that has put her through so much pain and almost snatched her life? “No. Because of cancer, I got the opportunity to come to Singapore and to be introduced to Christianity, which would have been unlikely in Vietnam. My dad and my brother live here and my mum commutes from Vietnam because she has a business there, so my family is with me. SCGS is a good school as well.” After ticking off all the advantages, My Linh sums up with a bright smile, “It has been good.” Another good thing that has resulted from her cancer experience is that it has given her an idea about her future career. “I admire my doctors very much. But they have to be so calm and kind to their patients. I thought of becoming a doctor but I don’t have their patience, so I’ve given up the idea. So I am now studying to be a pharmacist!”
奔向 胜利 美琳右脚的肿瘤不会阻挡她 完成人生赛程 那是一个天气晴朗的早晨，但滨海艺术中心外的公 路上却拥挤得水泄不通。虽然如此，今天的拥挤是 不会被人抱怨的，甚至是受到欢迎的，因为拥挤的 情况是由前来参加每年一度大东方女子竞跑的1万 5000名来自各年龄层妇女造成的。 在人群中，有一名来自新加坡女子中学 (SCGS)， 杵着拐杖的16岁女生。她参加的是五公里的赛程， 美琳的老师、家长和同学都相信她会完成整个路 线。 老师在她报名前这么对她说： “你不一定要跑，只 要按照你自己舒服的步伐去完成它就可以了。” 她的父亲也竖起大拇指告诉她： “无论是快是 慢，你最终一定可以抵达目的地。” 他的朋友们这么鼓励她： “我们会陪着妳。” 美琳并没有事先征询她的肿瘤科医生洪炳添或 骨科医生Khong Kok Sun的同意。 她笑说： “但我知道他们会怎么说。他们会说‘想 做就去做！’” 她遵循了自己的心意，在2012年11月11日那天，以 1小时24分钟的成绩完成了大东方女子竞跑 。 “感觉太棒了。这是我第一次参加竞跑！跑完了 我也不觉得累。我只是把它当成普通的散步。我到 达终点后，后面还有很多人呢！” 美琳是否为这次的竞跑做什么准备呢？她抱歉地 笑说： “我们在9月报名后曾队自己说我要更加活跃， 要挑战自己。但我并没有做什么特别的准备，我只是 在家里游泳，在上体育课时沿着跑道走走罢了。” 美琳在2012年11月10日成了《海峡时报》的新闻 人物。她杵着拐杖跑步不是吸引记者注意的原因，原 因是她是癌症生还者,对身边的人有很大的启发。 美琳九岁的时候就给诊断出患有骨肉瘤（或称大 腿骨瘤）。在越南，当年被诊断出患有这类癌症的病 人唯一的选择就是截肢。但截肢对美琳的父母而言 绝对不是答案。他们到处寻求良方，甚至不惜把女儿 送到美国接受治疗，但最终他们发现新加坡可能提 供他们另外一个选择。 她的母亲回想说： “我们到新加坡后，第一个问 洪医生的问题就是女儿需不需要截肢。当洪医生回 答说她可以保住双腿时，我真的非常高兴。”这个 答案让他们全家可以放心让女儿在百汇癌症中心 接受治疗。 2006年11月，美琳开始接受7轮化疗。与此同时， 医疗团队也开始为她寻觅适合的骨髓为她进行移 植。 洪医生解释说： “我们不为这类病人进行手术 而是给他们化疗。这么做的目的有两个：一是让我 们可以确定癌症是否队化疗有所反应，如果有，我 们不只可以控制骨头里的癌细胞，也可以同时治疗
希望的故事
完成大东方女子竞跑后，美琳和父母合照留影。
“感觉太棒了。这是我第一次参加竞跑！跑完了我也不觉得累。我只是把它 当成普通的散步。我到达终点后，后面还有很多人呢！” 美琳
微型病变细胞。微型病变细胞是没有办法通过扫 描探测到的。” “二来我们也是在拖延时间来为适合的骨髓移 植或义肢做准备。这么一来当我们最终做手术的时 候就可以替换截除的部位。” 病理学家对取自美琳腿上的肿瘤细胞进行检验 后发现化疗对她有效。医生之后为她植入骨移植 物，成功将骨内的缝隙合起。 美琳不经意地透露，她前后进行了7次手术，而且 以后可能还得动更多的手术。 “全身麻醉？手术后的疼痛？”这些让成人闻之 丧胆的字眼对她而言根本不是一回事。她说： “可能 是因为我从小就一直做手术所以不会太害怕。” 最重要的是她的脚得以保住。拐杖是为了给她额 外的支撑。美琳在各方面跟其他的女孩没有两样。她 甚至更加杰出，是新加坡一家顶尖女子学校的奖学 金得主。她热爱她的课外活动 - 女少年旅。只要提
起课外活动，她就生动地描述如何完成如为长者烹 饪或在家里帮忙，又如何通过她们赚取徽章。 她是否曾经抱怨癌症让她承受那么多的痛苦，甚 至威胁她的生命呢？ “没有。因为癌症，我才有机会来到新加坡，才 有机会认识基督教。如果我留在越南就没有这样的 机会了。现在我的父亲和哥哥都住在新加坡，母亲因 为在越南有生意要新越两地跑，我的家人都在我身 边。新加坡女子中学是一间很好的学校。” 总结所有益处，美琳亮出灿烂的笑容说： “我过 得还不错！” 另外，因为她的经验，她也更加清楚自己未来的 职业方向。 “我很仰慕我的医生。他们总是得要那么冷静， 对病人那么善良。我曾经想过要当医生，但我没有 他们的耐性，所以只好放弃了。现在我在学习怎么 当一名药剂师。”
Melayani Anda
Di usianya yang keen berkarya dan membe Dr Ang Peng Tiam, Direktur Medis Parkway Cancer Centre, berbicara tentang rencana PCC untuk mengembangkan model perawatan pasiennya ke negaranegara sekitar dan ke seantero dunia
D
i usianya yang keenam tahun, Parkway Cancer Centre (PCC) bersiap untuk memasuki tahap baru dengan meresmikan klinik baru di Rumah Sakit Mount Elizabeth, Novena. Klinik di Novena ini memiliki 10 ruang konsultasi ekspres, sebuah ruang konsultasi privat, dan dua tempat tidur pasien. Diresmikan pada tanggal 6 Agustus 2012, tim di klinik Novena dipimpin oleh dua orang ahli onkologi, Dr Patricia Kho and Dr Foo Kian Fong. Dr Ang Peng Tiam, Direktur Medis Parkway Cancer Centre, menjelaskan bahwa klinik Novena memungkinkan PCC untuk terus berkembang dan memberikan pelayanan yang terbaik dengan akses yang lebih mudah. “Fasilitas kami di Mount Elizabeth dan Gleneagles sudah mencapai kapasitas maksimal. Dengan adanya klinik Mount Elizabeth Novena, penambahan jumlah pasien dapat diatasi dengan bertambahnya juga jumlah dokter dan fasilitas,” demikian ia menjelaskan. Beberapa pasien juga bisa memilih untuk melakukan perawatan di klinik Novena karena klinik tersebut adalah satu-satunya di Asia yang memiliki fasilitas alat periksa PET/MR. Dr Ang Peng Tiam kemudian menambahkan, “Dengan memiliki dokter dan fasilitas lengkap di satu lokasi, kami dapat memberikan pelayanan terintegrasi yang nyaman bagi pasien penderita kanker.” Pengembangan fasilitas di Singapura hanyalah salah satu aspek dari rencana pengembangan PCC di masa depan. PCC juga sedang mempertimbangkan untuk menawarkan sahamnya kepada publik agar memungkinkan pengembangan layanan yang lebih luas ke negara-negara sekitar, demikian penjelasan Dr Ang, yang merupakan salah satu pendiri awal PCC. Dengan adanya klinik PCC yang tersebar di beberapa negara sekitar, berarti pasien tidak lagi perlu untuk datang langsung ke Singapura untuk mendapatkan perawatan. Salah satunya yang sudah berjalan adalah klinik berlisensi PCC untuk merawat pasien di Yangon, Myanmar. Diakui bahwa saat ini budget airlines memungkinkan biaya perjalanan yang lebih murah untuk pasien berobat ke Singapura. Namun jika PCC jadi memutuskan untuk go public, maka rencananya sebelum akhir triwulan pertama tahun depan, PCC akan mengambil langkah efektif untuk mengakuisisi salah satu perusahaan publik yang sudah beroperasi di Singapura. Menengok perjalanan PCC selama 6 tahun terakhir, Dr Ang mengatakan bahwa hal yang paling membanggakan baginya adalah kualitas pelayanan PCC, yang ditunjukkan dengan kecepatan waktu pelayanan dalam merespon kondisi pasien yang mendesak. Saat ini pasien memiliki pilihan yang luas dengan adanya berbagai fasilitas perawatan yang kompetitif.
Staf klinik baru PCC di Rumah Sakit Mount Elizabe
“Lebih dari 50 persen pa perawatan kami, datang dari teman atau keluarg bahwa apa yang kami la yang benar.” Namun Dr Ang percaya akan posisi PCC yang strategis, yang didukung oleh tim ahli onkologi yang handal dan terpercaya. Hal lain yang menjadi keistimewaan PCC adalah dukungan sosial dan psikologis yang belum tentu diberikan oleh klinik privat lainnya. “Lebih dari 50 persen pasien yang memilih perawatan kami, datang karena rekomendasi dari teman atau keluarga,” ia menambahkan. “Ini
Melayani Anda
nam, PCC terus erikan yang terbaik Perjalanan Sukses PCC: Interview dengan Dr Ang Perubahan apa saja yang sudah terjadi pada PCC sejak berdiri tahun 2006?
eth, Novena, yang diresmikan bulan Agustus lalu.
asien yang memilih g karena rekomendasi ga. Ini menunjukkan akukan adalah sesuatu Dr Ang menunjukkan bahwa apa yang kami lakukan adalah sesuatu yang benar. Rekomendasi dari orang lain yang dipercaya merupakan hal yang sangat menentukan kemana seorang pasien akan pergi untuk mendapatkan perawatan bagi dirinya sendiri.” “Sangat mudah bagi seseorang untuk berkata ‘Klinik sayalah yang terbaik kualitasnya’- namun penilaian dan rekomendasi orang lainlah yang menjadi bukti.”
Sejarah PCC sebenarnya sudah dimulai sebelum tahun 2006. Dr Freddy Teo dan saya memutuskan untuk membuka klinik privat pada tahun 1997, saat baru sedikit ahli onkologi yang bergerak di sektor privat. Persepsi umum pada saat itu adalah bahwa kanker masih merupakan penyakit yang belum bisa disembuhkan. Banyak pasien kanker yang meninggal hanya dalam waktu beberapa bulan atau beberapa tahun setelah diagnosa kanker ditetapkan. Hanya sebagian kecil dari jumlah pasien kanker yang bertahan hidup dan meneruskan perawatan. Banyak perubahan yang terjadi sejak 10-15 tahun terakhir. Berbagai terobosan baru ditemukan untuk mengobati kanker. Kami berdua mulai menjadi partner sejak tahun 1997. Pada tahun 2005, dua orang lagi bergabung. Mereka adalah Dr Khoo Kei Siong, saat itu kepala tim onkologi National Cancer Centre, dan Dr Lim Hong Liang, yang saat itu menjabat sebagai kepala tim onkologi National University Hospital. Tahun 2006, kami berhasil meyakinkan Parkway untuk membentuk kerjasama mewujudkan sebuah klinik khusus pengobatan kanker. Setelah itu, semuapun bergulir dengan lancar. Dibandingkan dengan kondisi awal, jumlah pasien yang kami tangani saat ini sudah mencapai dua kali lipatnya. Begitu pula dengan pendapatan dan jumlah dokter yang kami sediakan. Selain empat dokter yang merupakan pendiri PCC, saat ini kami sudah memiliki empat orang dokter lainnya. Kami juga memiliki seorang ahli pengobatan paliatif. Tenaga medis PCC juga diperkuat dengan tim onkologi radiasi. Kami juga memiliki spesialis onkologi pediatrik untuk menangani pasien anakanak. Dengan tim yang lengkap dan terintegrasi, kami menawarkan pilihan perawatan yang lebih luas kepada pasien. Salah satu impian saya adalah menyediakan banyak informasi yang edukatif, seperti newsletter, untuk memberikan semangat pada pasien dalam menjalani proses pengobatan mereka. Hal ini tidak mungkin dilakukan oleh saya sendiri. Tetapi dengan kerjasama tim yang saling mendukung di PCC, kami bisa mewujudkan hal ini. Saat seorang pasien sudah tidak dapat menggantungkan harapan lebih jauh lagi pada Bersambung ke halaman berikutnya
Dr Ang menjawab beberapa pertanyaan tentang perjalanan Parkway Cancer Centre
Melayani Anda
Fasilitas di klinik baru PCC di Rumah Sakit Mount Elizabeth, Novena, termasuk 10 ruang konsultasi ekspres, sebuah ruang konsultasi privat, dan dua tempat tidur pasien. Dari halaman sebelumnya
pengobatan medis, dan kunjungan ke rumah sakit menjadi terlalu berat, saya percaya akan pentingnya memastikan perawatan yang menyeluruh di rumah. Pemikiran ini mendasari dibentuknya tim perawatan rumah, yang dipimpin langsung oleh ahli pengobatan paliatif kami. Semua yang saya sampaikan tadi hanya mungkin terjadi dengan adanya kerjasama tim yang kompak.
Apa yang paling membanggakan dari pencapaian PCC selama 6 tahun ini? Banyak hal telah berhasil kami wujudkan. Banyak pula dokter yang ingin bergabung dengan kami. Tim dokter kami saat ini berjumlah delapan orang, dan mulai Januari 2013 tim kami akan bertambah dengan satu orang dokter lagi. Beberapa dokter menyampaikan bahwa mereka tertarik bergabung dengan kami karena mereka menilai cara kami merespon kondisi pasien kanker adalah tepat. Hal yang paling membanggakan bagi saya adalah apa yang kami tawarkan pada pasien, yaitu diagnosis yang sangat cepat dan akurat. Umumnya dalam waktu 24 sampai 48 jam, kami sudah dapat menentukan jaringan organ yang terkena kanker, menentukan luasnya penyebaran kanker dan kemudian merekomendasikan jenis perawatan yang diperlukan oleh pasien. Respon yang efisien tersebut dimungkinkan karena kami melakukan diagnosis yang menyeluruh, dimana ahli radiologi, ahli radioterapi, dan dokter bedah terlibat dan bekerjasama lintas disiplin. Dulu dokter bedah mempunyai pertimbangan bahwa jika pasien penderita kanker tidak dioperasi secepatnya, dan sebaliknya malah disarankan untuk mendapat perawatan lainnya dahulu, maka kondisi kanker tersebut akan memburuk dengan cepat. Namun, dengan memperlihatkan hasil kemoterapi yang dapat mengurangi ukuran tumor sebelum tindakan operasi, para dokter bedah dapat diyakinkan bawhwa kemoterapi sebagai perawatan awal adalah tindakan yang tepat untuk pasien penderita tumor yang berukuran besar. Contoh serupa lainnya, pada beberapa kasus dimana kami cenderung menganggap kondisi pasien sudah tidak memungkinkan untuk dioperasi, tim kami malah merekomendasikan hal yang sebaliknya.
Ini karena dokter bedah kami bekerja sama dengan ahli-ahli lain dalam tim yang terintegrasi, sehingga memungkinkan kami untuk melihat secara lebih komprehensif bahwa tindakan pembedahan malah dapat meningkatkan harapan, walaupun kondisi penyebaran kanker mungkin sudah meluas. Hal ketiga yang membuat saya bangga adalah dukungan psikologis dan sosial yang didapatkan oleh pasien kami dari para perawat, tim pengobatan paliatif, dan konselor CanHOPE. Bahkan belum lama ini, seorang pasien bercerita pada saya bahwa satu-satunya alasan ia mempercayakan perawatan kankernya di Parkway Cancer Centre adalah karena ia mendapatkan informasi bagaimana kami mendukung dan menyemangati pasien untuk berjuang melawan kanker dan mengatasi efek samping dari perawatan yang sedang dilakukan.
Saat ini iklim kompetitif lebih terasa dibandingkan dengan tahun 2006. Apa yang menjadi pertimbangan pasien untuk memilih Parkway Cancer Centre daripada klinik onkologi lainnya? Apa yang menjadi keistimewaan kami? Yang pertama pastinya karena reputasi para dokter kami. Tim inti Parkway Cancer Centre terdiri dari para ahli onkologi yang sangat berpengalaman. Fakta ini adalah penentu utama posisi kami di bidang ini. Yang kedua, kami merekrut para ahli onkologi terbaik dari generasi kedua dan ketiga untuk memperkuat tim kami. Selain itu, kami juga berusaha untuk merekrut tenaga perawat yang terbaik. Kami mempunyai tim dukungan yang disebut CanHOPE, yang tidak ditemui pada klinik onkologi privat lainnya. CanHOPE tidak hanya ada di Singapura, namun juga pada kantor-kantor kami di Bangladesh, Kamboja, Indonesia, Vietnam, Filipina, Rusia, Sri Lanka dan Myanmar. Para pasien dapat merasakan bahwa kami berusaha untuk memahami mereka dan membuat mereka merasa lebih nyaman. Walaupun mereka mendapatkan perawatan di Singapura, saat mereka kembali ke negara asalnya, mereka dapat tetap berkonsultasi dalam bahasa dan budaya mereka sendiri, dengan konselor CanHOPE yang dapat memahami masalah mereka.
Serving You
A
young Benson Soh was beaming with pride at his A Level results slip when he started thinking about what he should study in university. Political science? Business? Economics? All struck him as subjects which were “too boring for my liking”. But one particular discipline caught his attention – Social Work and Sociology at the then University of Singapore. “I was curious, wondering what it was all about. All the other options seemed quite dry to me.” When Mr Soh found out that he would be studying about the individual, about how every person fits into society, and about how to help the disadvantaged, he was sold. “I wanted a meaningful job, not just something that would earn me money. But something that would give meaning to what I do,” recalled Mr Soh, now 54. Not so easily sold, though, were his parents. “They thought I was crazy, choosing the profession that was the most poorly paid of all,” said Mr Soh. “My father told me: ‘Now’s not the time to do charity work.’” His father had dreams of his taking up a bank job and wanted him to follow the money and read economics or a business-related course. But Mr Soh stood his ground and eventually, his parents relented. And Mr Soh has never regretted his career choice and has stayed the course over the last 32 years. His career in social work has seen him counsel troubled youth at the Singapore Children’s Society, suicidal people while at the Samaritans of Singapore (SOS) and terminally-ill patients at the Parkway Group. Mr Soh started out as an officer at the then Ministry of Social Affairs, but left just three months later as he did not like doing research and deskbound work. From a comfortable government office, he found himself operating out of “rubbish dumps”, as he described it, immersing himself in the heartlands to reach out to troubled youths. Void decks and playgrounds were his “office”. He started out all gung-ho, wanting to “charge in to rescue the poor victims and save the world”. But he soon realised that he needed to do things at the pace of those he counselled, rather than at his own pace. “I could not understand why people who have been abused would want to continue being with the people who beat them and even stay in a relationship with them,” said Mr Soh. “But I realised that for some of these women, it is even more frightening for them to be taken out of an environment that they are so used to.” He added: “This was something I could not understand at first.” Such exposure allowed him to really put himself in the shoes of those he counselled. “It made me change my mindset and approach to my work. I truly learned to put myself in their shoes and empathise with them rather than let my own feelings interfere with how I help them.” Mr Soh joined Parkway Pantai in 1996, where he was involved in pastoral care for terminallyill patients and their families. He joined Parkway Cancer Centre (PCC) in April 2012 and is also part of CanHOPE, a non-profit cancer counselling and support service provided by the PCC.
A job with ‘meaning’ Benson Soh’s parents thought he was crazy when he chose to go into social work and sociology. But he has never regretted it On most days, he sees three or four patients or their family members and does his usual rounds of the hospitals under Parkway. He also provides psychosocial assessments on patients and their families, conducts individual and group counseling; facilitates support groups, as well as run talks, training and educational workshops for those affected by cancer. He describes his time working with terminally-ill patients as being “much more intense” than working with youths or suicidal people. “Here, I have to journey with a patient over a few sessions so I follow their ups and downs as well,” said Mr Soh. There are never simple cases, when it comes to counselling. “Human beings are so individual and dynamic. No matter how simple the person’s case might seem from the surface, you can never take for granted that it will be straightforward.” The most challenging part of his work is that the “prescription” he gives out is not something they can take, like medicine. “I’m more like a guide or a shepherd, to guide patients and their loved ones through the painful journey so that they can see some meaning outside of their suffering,” he said. Mr Soh said he does not let his work get him down. “By nature, I’m a very positive and cheerful person, so that helps. My wife and I also support each other emotionally and psychologically as well. I always look forward to going home.” To stay active and positive, he exercises a lot. He used to run long distances of up to 30km, but stopped after an injury. He now prefers taichi and swimming. Mr Soh has no regrets about his choice more than three decades ago. As a plus, he also met his wife while working at the Singapore Children’s Society, where she was also a social worker. “I have no regrets at all. It’s a job I really love.”
“My father told me: ‘Now’s not the time to do charity work’.”
Mr Soh
The Doctor Is In
“I For more than five hours, a doctor stays by his patient’s side in the operating theatre
Much as I enjoyed being part of the action, I am more convinced than ever that my place is in my clinic.
need four units of packed red blood cells, one litre of fresh frozen plasma and one unit of cell separator platelets as soon as possible,” I asked as calmly as I could. “Please!” I added, slightly hysterically, because I was looking at a patient bleeding his life away. The monitors indicated a blood pressure of 40/20mmHg and his haemoglobin was 2.9g/dl (normal being 12.5 g/dl). I really didn’t want to be in the operating theatre. For more than 10 years, I have successfully dodged such invitations, by saying jokingly that I faint at the sight of blood. Tr u t h i s t h a t a medical oncologist has very little to do inside an operating theatre, where the surgeons rule. But this patient and his family would not take no for an answer. “Please, Dr Ang. You are like his guardian angel and we need you in the operating room with him,” the family pleaded. “Alright! I’ll go in for 10 minutes. Only 10 and then I’ll leave the surgeons to do the work,” I yielded. The patient is Eddy, a 40-year-old Chinese, who was first diagnosed to have metastatic gastrointestinal stromal tumour (GIST) in March 2008. Initially, he responded marvellously to a medicine called Gleevec. Despite the most aggressive treatment programmes, in the past, all the patients with metastatic GIST fared poorly and most would die within a year of diagnosis. In May of 2001, Gleevec was approved for treatment of GIST. By popping four tablets every day, the tumour would melt away within a few months. Patients with metastatic GIST require a long-term treatment. Discontinuation of the drug is not an option as the tumour would return with a vengeance when the drug is stopped. Unfortunately, in some patients, the tumour can acquire resistance against the drug. Eddy came to see me when his tumour was growing despite Gleevec. He was admitted to the hospital with severe abdominal pain caused by a spontaneous rupture of his bowel. By then, his abdomen was markedly distended, to that of a fullterm pregnant woman. To relieve his breathlessness, a small tube was inserted into his abdomen to drain the fluid. Each day, litres of bloody fluid would pour out from his abdomen. He suffered from severe infection as the bowel contents emptied into the abdominal cavity. Despite antibiotics, the infection became worse and the bacteria started “eating” holes in his abdominal wall. We nursed him for almost a month in the intensive care ward. Ventilated on a respirator, cleansed with continuous dialysis, he was brought back from the
brink of death to good-enough health to consider surgery. “We have a window of opportunity to go in and try to clean up the mess,” I explained to his family. The objectives of surgery were clearly defined – repair the perforated bowel, stop the bleeding and take out as much of the tumour as possible. Dr Richard Chew, a senior general surgeon, was selected to lead the three-man team. Half an hour into the operation, I peered out from behind the backs of the surgeons to see an exposed abdomen. There were masses of cancerous tissue packed in the upper half. In the lower abdomen, his small intestines had ruptured and turned inside out. And, there was blood everywhere! I watched and tried not to bite my nails as the surgeons calmly clamped off and tied up one bleeding vessel after another. “ G a u z e . To w e l . Suction. Artery forceps. Stitch.” The team of doctors and nurses worked with few words and much efficiency, like a well-rehearsed dance. As the only member of the audience, I watched in awe as the surgeons operated. At the patient’s side, the anaesthetist was hard at work trying to maintain the blood pressure. He and his nurse were frantically drawing and injecting blood into the patient’s veins. I put myself to good use by helping to call for blood. I can’t remember how many times I spoke to the medical officer on duty at the National Blood Centre, each time more frantic than the last. What I do know was that my 10 minutes turned into five and a half hours. During this time, we poured 12 litres of blood into the patient. This did not include all the other fluids which were also infused to support the blood pressure. In between my operatic phone calls, the surgeons managed to remove part of the damaged bowels, repair the smaller perforations in Eddy’s intestines, staple off part of his stomach that had been invaded by the cancer, stop the bleeding, and cut off more than 80 per cent of the tumour. By God’s grace, both Eddy and I survived the operation. As the attending physician, I am grateful for the tremendous effort of the entire care team – from the surgeons in the hospital to the duty medical officer at the blood bank, from the intensive-care nurses to the theatre attendants. Much as I enjoyed being part of the action, I am more convinced than ever that my place is in my clinic, beside the examination couch, rather than on the operating floor.
Operation
Radical
Dr Ang Peng Tiam
