Archive for April 2013

0630 hrs, Monday

Reported at admission, Royal Perth Hospital, with a lucky angbao given by a friend in my pocket.

0650 hrs, Monday

Was called to the counter, thanked for my patience, apologised to for the delay. Checked again with the lady if there was any payment whatsoever I needed to do for this surgery and my probable hospitalisation. She gave a firm confirmation everything would be covered under Medicare and there would be no out of pocket expenses.

0700 hrs, Monday

Was one of the three called out by an elderly guy and was asked to follow him. We were led a level up and across a bridge painted with colours to another department. Everyone was allocated a cushy chair with a number on it.

0720 hrs, Monday

Before long, a nurse attended to me did a huge pile of paper work for me in an interview style. I didn't have to touch the pen the entire time, not even a signature because that was already done at the pre-admission. As the nurse was so familiar with the paperwork, it was a breeze. Once the chore was over, she handed me the standard sexy gown every patient had to wear, with a kinky disposable underwear no less and got me to put the rest of my belongings in a designated bag. I was told that bag would land up in the drawer besides my bed in the ward that I would end up after the operation.

0800 hrs, Monday

The waiting game began. I was told I was the third on the list that morning. I nodded in acknowledgement. My mobile phone was almost depleted for answering questions from friends in Singapore, especially my bored neighbours at work on a Monday morning, looking forward to the Labour Day public holiday a couple of days later.

1000 hrs, Monday

I was called by the same nurse to get on to the bed in the same waiting room. Once done, a hospital hand appeared and was instructed to take me where I should be going. I couldn't remember where I went though I remembered crossing the colourful bridge again. I really felt like a patient that time. The first time in life I realised I was in real trouble, being in those scenes in Chinese dramas in the 80s. Only thing was that no there wasn't 5 other people sprinting along with the hospital hand in those scenes.

1010 hrs, Monday

I was given a 'window bed' in yet another waiting room. It was a nice feeling being near the window. I didn't know where I was but I saw a Western Power building outside. I couldn't help but realise how Perth City seemed alien to me, the way Singapore's 'town' was to me. It was a habitual thing to avoid the city I guessed. That would probably be something I would carry with me no matter where I go. My identity was tripled checked by at least 2 or more staff from different departments. I was told I would be the next to go under the knife so it wouldn't be long.

1030 hrs, Monday

Interestingly the room was filled with posters unprofessionally pinned on the ceiling boards. It must be the staff's idea of killing the boredom of the waiting patients. Unfortunately they were not exciting pictures. I remembered a couple, a picture of the London bridge and Caversham Wildlife Park. After 5 minutes, the posters outlived their usefulness. I began to observe everything from gloomy patients, medical staff joking non-stop nearby, medical equipment and hurried staff near the door, buzzing with activities.

1100 hrs, Monday

The anesthetic guy came back and said I must have thought they forgotten about me. In fact the guy before me were having problems with his stones eliminated by laser so that took longer than planned but it was be over soon.

1130 hrs, Monday

The action began. I was pushed through corridors again into a sombre room. That was that. I began to feel nervous for the first time. 6-7 medical serious looking medical staff began to work on me, sticking things, checking blood pressure and what not. Unfortunately the anestheic guy was as nervous as me. He tried to look confident but I knew he was bullshit as after he missed his target twice. The second one was unforgivable because that position was 'well seasoned' after my 50 odd times of blood donation. The drip ended up at the front of right elbow. I couldn't even remember getting drowsy and eventually to sleep. It was as if a few hours of my life was taken away from me. That was why so many people have fear for surgery I supposed, leaving your life entirely in the hand of strangers who have seen death so many times that they have developed immunity. And you are just another number.

1400 hrs, Monday

I must be asleep way after the operation. When I woke, I felt a distinct discomfort at the one of the man's most vulnerable organ. I reached down and felt the catheter attached to it and whispered, "Damn." I took hours to come to terms with my new temporary organ. Discomfort was a weak word to use here, as sensation was quite difficult to describe that it would take me more energy I could muster for a satisfactory attempt. I was encouraged to drink as much water as I could and I tried to. I couldn't feel my urine passing out the same way because it simply flowed through the catheter into the external bag. Occasionally I would feel short, electric shocks-like sensations on my urine tract. I gathered it could be my urine flowing through.

I lost track of time. I was so drowsy all the time and simple had nothing to think of but coping with the strange artifact attached to my urethras because I had to live with it for many more hours that I preferred.

I caught the moment when Jen and Albany appeared from the doorway. Albany's eyes sparkled, pointed to me with her short fingers and said, "Deh deh." I felt homesick immediately but I knew home wasn't a good place for me at that moment. I thought I fell asleep multiple times and hardly remembered communicating more than a few lines with Jen. I could only recall saying, "Watch her," after I saw Albany walking around the place greeting other patients with her innocence. It seemed soon Jen, Albany and Grace bided me goodbye but I knew hours would have gone by.

2000 hrs, Monday

"Did you eat?" Someone called out to me. I shook my head, still groggy. "Ah, they saw you sleeping and didn't give you food." Then she disappeared and returned shortly with a tray of food. I thanked her and feasted awkwardly supporting my body with the elbow with my drip. Before the guy on the opposite bed called out to the nurse to help adjust the angle of my bed as the controls were placed beyond reach, I had already finished my meal. The remote control was brought within range.

There were two nurses attending to me. One registered nurse in blue, a beautiful European looking girl in her late 20s with redish gold hair. She didn't have an Aussie accent so I was sure she wasn't born here. I didn't know her name because there wasn't a name tag on her uniform. The other nurse was in white. A student-nurse from Curtin University, but she was surprisingly competent. Her name was Shirleen and she looked and sound VERY Singaporean. She probably knew or suspect I was Singaporean as well and communicate to me with twinkles in her eyes. I couldn't help but recall an important discussion with Tucky, my old buddy in Singapore about getting treated in Singapore vs Perth. His replied was simple and curt, "You wan your kkj handled by Pinoy or Blonde?"

0600 hrs, Tuesday

Unfortunately, in the end no blonde or Singaporean handled that. Their shift was handed over to a night nurse from either India or Sri Lanka. She went through her duties mechanically as if she was dealing with machines. Left the curtain screens wide open whenever she came in, I couldn't sleep with lights on. Sigh. She was pretty rough when she took blood pressure and I wasn't looking forward to her removing my catheter for me.

I was right. She was rough and ruffled around with the tubes and pee-bag. I could feel a lot of those 'electric shocks' as she rummaged around. I wanted to ask her what was the hurry but decided not to say a word. Wise men shouldn't. Before long she was ready and told me to take a deep breathe...

I didn't make a single sound during the torture but I tell you, I wouldn't wish upon even on my enemies to suffer a catheter removal procedure. I spent the next 10 minutes completely motionless to come to terms with the pain in the depths of my urinal tract. In fact, I suffered a little trauma with flashes of that split second ordeal for much of the following day. I couldn't help but wondered why CIA or FBI spent so much money on lie-detactors or interrogation methods where there is a cheap and effective way to get a man to spill the beans clean after just one or two times of 'cleaning of the barrel' at most.

Before I could get out of my shock, I overheard the nurse moving to the next bed to perform the same ritual to the chap. The steps were exactly the same. I could heard the guy chatter a little, probably in excitement at the thought of removal the offensive equipment from his wee wee. When I overheard, "Take a deep breathe," I took a deep breathe for him too.

"AWWWW, fucking SHIT!" the poor chap wailed out and woke the whole room of patients. "Ahhhhhh......" he groaned. I could picture him slowly relaxing all his tensed muscles then. I chuckled quietly. I started to flex my own urinal muscles a bit. Despite the raw obvious pain, it felt liberating. I could move my legs without the electrifying sensations. I melted back into bed in relief, I could smell breakfast.

0730 hrs, Tuesday

I had breakfast. It was good. The two pretty nurses came back to the shift, greeted me and brought me news. All they needed from me was 3 pees that passed their requirements and I would be free to go! I started to load up on water but I wasn't looking forward to the first pee at all.

0800 hrs, Tuesday

I stood up from the bed for the first time. I felt very unsteady. The effects of anestic and being in bed for more almost 24 hours. I expected a little disaster but not quite the way it happened. Blood began to drip from my wee wee uncontrollably. Before I could react, I had more than 10 spots of fresh blood on the floor. Damn it. I danced around the spots and reached out for the urinal pot and began to pee, blood and all, pain and all.

Ouch. I couldn't remember my urine flow being fast and strong for a while now. I was slowing down the flow instinctively because the stream felt like bolts of lightning jumping through the urinal tract. I finished with a blood red pot to hand over to Shirleen. The redish gold haired girl came in shortly and saw the mess I created on the floor. She looked disturbed so I knew it was unusual. I also took a peek at the pot that the guy next bed submitted. It was a pale red. He wasn't bleeding much.

I remember Grace dropping by earlier on to tell me my recovery was near miracle in her eyes because for her years of experience, she had never seen a pee bag so clear before. So she concluded that my surgery was totally spot on and well done. My new wounds must have been incurred during the extraction of the catheter.

I passed the first pee with a residual urine of 60cc. Not ideal I would say but you wouldn't think of acing tests in times like that. The second pee was similar, with less blood and I avoided making a mess on the floor this time. I clocked 65cc of residual urine. Hmm, getting worse, buddy. I drank a lot of water for the third one. I wanted to flush as much blood out as I could and also test my bladder to see how it was working. There was a rather long break between the third pee and my scan, Shirleen was puzzled as she did the ultrasound on my bladder. She giggled a bit and said, "Er, that was 330cc left in there."

Hmmm... before long Red-goldie was informed and she popped by and told me that was a crappy attempt so I would need to do better to pass. I told her I would try again immediately. It took me a few attempts to empty my bladder completely. I cheated a bit by looking at the measuring mark of the urinal pot. Despite my attempts, I couldn't get the urine pass the 310cc mark and I called it a day.

I had a few nervous seconds watching Shirleen's poker face as she probed around my bladder. "Are you taking averages on something?" I asked. Shirleen smiled and explained, "No, every point is a reading itself. I just needed confirmation."

"So, how am I doing?"

"Not bad, 37cc remaining." Shirleen was pleased. I was pleased.

It was time to wash up and go home. I walked to the toilet shakily to brush my teeth and wash up. Red-goldie removed the last needle on my body and told me I could get dressed and wait for my medication.

1030 hrs, Tuesday

I met her at the discharge counter. She did everything for me, my medication, scans, MC, follow up appointments all in one bag (no bills felt really good) and gave me one last smile before I staggered out. I regretted not thanking her for taking good care of me. I didn't even have a name to send a thank you card to. All I had in mind then was to get out, it felt like a prisoner set free.

1100hrs, Tuesday

Home sweet home. The car ride wasn't pleasant. I felt some pain and slight bouts of neaous. I reckoned I shouldn't sit and compress my bladder too much at this stage. So it would be standing or sleeping most of the time for the next couple of days.

I want to send a thank you card to all the team who took care of me, yes including the nurse who was a little rough. I do not know whether that was world class or not. I felt cared and in safe hands all the time. I can't be anymore grateful to the staff of Royal Perth Hospital. Let me work on the letter tonight.

The millions of cancer cells can that formed the tumor in my bladder were burnt to death last afternoon. They were once part of the billions that formed me. They were a small part of me, which functioned and contributed to the physical shell of my soul.

These cells were expected to divide and die, divide and die just like every other cell. But everyday, cells turns defiant and does not comply to the rules of dying after division. Everyday in a healthy body, these long lived cells are killed by other normal cells. We call these fighting cells the immunity system.

There comes a time where health of a cancer patient like me deteriorates to a level when the immunity system no longer fights the rebellious cells as before, allowing these cancer cells to multiply, sometimes slowly and sometimes rapidly, until they become disruptive to the normal functions of the body.

Removing cancer is a start not the end. For the reason why a camcer tumor is formed in the first place is poor health. Ignoring that, cancer will return, and return like a deadly summer fly.

Cancer cells are not bad. They are simply nature, doing their jobs. Think of them as phelgm. Nobody likes it but its presence tells you something is wrong and you need to act. Be it giving yourself rest, nutrition or water.

To put it in perspective, people like me are probably regarded as cancer by our government. We are bad publicity to the flawless image of our beloved country. We do not function as normal citizens, work, procreate and die. We question the policies of the government, they call that complaining. They can't wait to see us leave. Good riddance to bad cancer.

However they fail to see the reasons why people like us change from good abiding citizens to cancer. We may be forced to leave, replaced by new cells but cancer will keep forming until the system, plagued with illness, is addressed with the right cures.

There lying on this hospital bed with needles and wounds, I pray for the recovery of my health, as well as my beloved homeland, Singapore.

Perhaps I can finally understand how hard it was to persuade my dad to go for surgeries. Some people thought it was fear. We thought so too. That might be true for someone who has never gone under the knife before. The thought of going to sleep into the unknown waking up never the same again, in hope for better but often enough reported for worse. It was worse when money came into the equation. When the initial surgery did not meet expectations, the high cost of medical in Singapore made things complicated. Lost faith was hard to restore, especially when doubts were constantly creeping in treatment after treatment that failed to rejuvenate the health to former glory.

Even for a well informed patient like me who could tap on the resources of the internet and educated enough to weigh the pros and cons of treatment could not avoid fear the fear I couldn't, or perhaps didn't want to, connect when I sent him to the hospital to go under the knife. It is good for you. It is neccessary as you are unwell. Cheap words never too hard to offer.

It was just me to be cynical. It is hard not to doubt. I think doubts are neccessary. For without doubts, how will we know the real desires of the heart? What I think is important is the ability not to allow the noise to cloud the inner voice. Every Singaporean who migrated to Perth like me would have resisted the deep persistent murmurs of doubt which never stop to linger long after we set feet here.

It was a subconscious effort when i made a decision to leave Singapore. For my fight with cancer, M's dad encouraged me to communicate directly to the inner voice within myself instead of relying on the subsciousness or gut feelings. Not just for this surgery but for the long extended war beyond that.

At the eve of the surgery, there was little nerves. I love these lazy quiet afternoons where life had no expectations of me. Where the highlight of the afternoon was killing my first Redback with boiling water. Slick job. Where I had the mood to get dirty under the car to top up my leaky engine and to flush the radiator and refill the tank up to its deserve with clean, new coolant. Old as it is, good as new. That is what they will do for me tomorrow.

Take care of yourselves my friends. Think you wouldn't get cancer? Take me, not join me, as the lesson.

Some facts about bladder cancer from the internet

Smoking is the greatest risk factor. Smokers get bladder cancer twice as often as people who do not smoke.

I don't smoke.

Chemical Exposure: Some chemicals used in the making of dye have been linked to bladder cancer. People who work with chemicals called aromatic amines may have a higher risk. These chemicals are used in making rubber, leather, printing materials, textiles, and paint products.

I was not exposed to chemicals

The risk for bladder cancer increases with age. Over 80 percent of people with bladder cancer are over age 65.

I am under 65.

Caucasians are twice as likely to develop bladder cancer as African-Americans and Hispanics. Asians have the lowest bladder cancer rates.

I am Asian.

Individuals with family members who have had bladder cancer are more likely to develop the disease.

No family members had this disease.

Individuals who have previously had bladder cancer have an increased risk of developing the disease again.

I didn't used to. Now I do.

Chronic bladder infections or bladder stones may be linked to certain types of bladder cancer.

I was infected but not treated after I visited the doctor. Lesson here: You only need to screw one once.

*****

Bladder cancer has a recurrence rate of 50-80% and because it requires life-long surveillance, it is the most expensive cancer to treat on a per patient basis. It is estimated that approximately $2.9 billion is spent in the United States each year on the treatment of bladder cancer.

As we can see, I am on the wrong end of statistics. With a 50-80% recurrence rate, it doesn't sound very positive for any cancer patients who yearn for a normal life after treatment. Hard as it is to accept, I may be fighting cancer for the rest of my life. For some, the thought of that is enough to kill.

My friend sent me a blog of her ex senior in school who shared his accounts of his fight with Leukemia. It has no updates anymore because he lost the fight. For some reason, it seems that bloggers tend to lose their fights with their illnesses. Each one probably hope he or she will not add to the statistics. I must admit I received a fair share of emails from friends and strangers telling me they are keeping me in their prayers. It will be quite a disappointment to religious people if their prayers don't work as they cannot use the reason that, "God took him at his side," because I know very well I am going straight to hell as a free thinker to be tortured for eternity (as warned by a dear friend) So, I better survive as long as possible and die at a rather normal age, preferably not from cancer. That way, I can reciprocate to the nice folks who prayed for me and make them feel good that their prayers are answered.

It is interesting to know that the majority of prayers are going to Jesus Christ. I assumed it will always be, unless otherwise stated. My friend Gintai is the first one who sent a "Lord Buddha will watch over you," over. When I told him about that he simply replied, "Jesus is too busy, let Buddha do some work." Ha. I love that reply. I hope no one is offended by that. I grow up with a buddy as free thinker. We laugh at everyone but always ourselves first.

A dude even sent me a message telling me he will pray for me, though he doesn't know how it works because he is a free thinker. That sent me chuckling. Along the same lines, what I want to say is that though I don't know how prayers can help me, what I really appreciate are the kind thoughts of the people who reached out to touch me. That alone was enough for me to feel that the universe is backing me in whatever I am setting out to do. Thank you everyone, for the nice gestures. That will fuel me for the journey of my diverted path of life.

The suggestions:

Go to Singapore to get treated by world class specialist, come back to Perth and continue life.
As above, except for staying in Singapore for good, with parents helping out on Albany so Jen can return to the workforce.
Stay in Perth to get treated.

The dilemmas. In order to get well, these are generally recommended:

Family support
Good recovery environment
Keeping the mind settled and a happy mood at all times
Proper diet
Adequate rest at right timing
Good medical treatment

Let's calm down and think with the mind. We need to do that now. Knee jerk reactions by going with the emotions of the heart are not going to help matters. First, we need to understand cancer. There are so many misconceptions about the illness. That is why we need to know as much as we can, so as to make the most rational and practical decision for ourselves.

Unfortunately, cancer is not simply a 'cut-it-off-and-bye-bye', or 'drown-me-in-chemo-juice-and-bling-bling' or 'zap-zap-the-naughty-cells-and-die!-die!-die!' process. There is a lot of close monitoring and follow ups involved after whatever treatment that I have to undergo. It can end up in years, or even a lifetime of follow ups. No doctor in the world can guarantee one perfect treatment will see my problem gone from my life once and for all. With that in mind, getting treatment in Singapore and coming back is totally out of my consideration. Do I fly back each time for a follow up scan? First, it is not financially viable. Second, it is very disruptive to my life and work (yes, I still need to work) How about doing the surgery in Singapore and the follow ups in Perth?

Would you complicate your case, risk miscommunication or misinterpretations if you were in my shoes? You will never be able to put yourself in my shoes because you don't have cancer. We can always imagine how a bungee jumper feels doing his jump, perhaps even vividly, in our minds but it will never be the same until you make that jump yourself. My answer to my question: I wouldn't.

2 options remained. 1) Go back for good. 2) Stay here.

Family support : Singapore vs Perth

No doubt. Getting everyone around and wrapping me in cotton wool feels good. I love my family and I strongly believe having them around helps in my case. The dynamics of going back to Singapore can be quite disruptive. It was already a little nightmare moving from Gosnells to where I am a couple of weeks ago. At the moment, I couldn't imagine making arrangements, booking tickets, packing (again? fuck no!), saying goodbye to my boss and colleagues without giving notice and land in Singapore with little money, no jobs for both of us, a fast growing active little girl who couldn't sleep a night well in Summer due to the heat and the bonus, cancer cells in my body.

With treatment happening in Perth in 3 days' time. I reckoned there isn't a possibility going under the knife of a world class surgeon in Singapore within that time frame without spending a lot of money - which I don't have. As much as I love to have my family around me for support, it is technically very inappropriate at the moment. The last thing I wanted now is instability. I needed a huge chunk of the peace of mind now and focus on listening to my body and work with it to battle the time bomb within me.

With Albany delighting me with her overflowing cute antics and generous kisses (yes, she learnt how to kiss me on the face, with the sound effect no less) each evening after work, my worries melts away. She gives me hope, strength and she doesn't nags. She is my key healer.

Good recovery environment: Singapore vs Perth

Air. Enough said.

Keeping the mind settled and a happy mood at all times: Singapore vs Perth

I've written 126 blog posts on Singapore and finally attained enlightenment, being able to let go and look forward. "What do you think?"

Proper diet: Singapore vs Perth

It is a close call between "There is no freshness like Coles" and "Cold storage, the fresh food people". I have received a lot of useful information by my impromptu dietrician, V, so I think I should be in good hands in Perth.

Adequate rest at right timing: Singapore vs Perth

Previous Job in Singapore:

8am - 6pm, 6 days full week
Over minimum 10 hours unpaid overtime per week.
Reaches home at 8pm earliest
Commuting takes average of 1 hour per trip, 2 hours in total.

Current job in Perth:

7am - 3.30pm, 5 days week.
Knocks off on the dot everyday.
Occasional overtime is payable.
Reaches home by 4.30pm
Commuting is maximum 30 minutes each direction, 1 hour in total.

I cannot remember the last time I slept before 12 midnight in Singapore. In Perth, I am hitting the sack at 10pm recently, not later than 11pm. I am a very light sleeper who wakes at a minimal amount of noise and light. I find myself sleeping better in Perth. No comparison.

Good medical treatment: Singapore vs Perth

The jury is always out. My personal experience [link] however, left me very little faith in the Singapore medical system. I believe a part of healing is attributed to faith. Thus with broken faith, I seriously doubt I would be doing very well in Singapore.

Conclusion

A unanimous nod to Perth.

Wish me luck.

Despite the popular tongue-in-cheek Chinese notion of "在新加坡可死不可病"，many of us regard Singapore as a world class medical hub. Hmmmmmm. As if we Singaporeans do not know how things in Singapore works. Let's take a look at a couple of aspects in life before coming back to the medical system.

Education. Singapore has a very good record of producing youth winners of international maths competition and what nots. You have to have an impression at least, because each time we do the prostitute press will spread her legs and show everyone her red panties marked 'Singapore, maths champions!' Singapore has also maintain a relatively strong standard in other academics. So what does that make us, a world class educational system? Strangely, every single Singaporean with kids that i met in Perth told me they came because of their kids. Why are we downgrading our kids from a world class education to well, a not so world class one? Isn't parenting about giving our kids the best that we can? Mystery.

Jobs. Open your eyes and look around you. How many CEOs of MNCs are Singaporean? Do not name me the military croonies heading a GLC as an example. We know very well what is going on there. Chances are, finding a Singaporean CEO is like finding a needle in a haystack. That isn't pertaining to the top man only. Look further down the hierachy, you will find it is rare that Singaporeans hold top management postitions in big companies. What does this tells us about our vibrant job market people all over the world are flocking to, in the country with the highest GDP in the world? Are Singaporeans not capable enough to run the shows after emerging from almost 2 decades of world class education? What are we missing here? Whatever it is, yes, there are big money to be made in the vibrant job market of Singapore. If you are reading this, chances are you are not one of them with access to it.

In a few years' time, a large percentage of Singaporean drivers see their COE expiring. It will be decision making time then, to choose between purchasing a license close to 6 figures to drive their next car for the next 10 years and hopping on the other segment of our world class transport system. By then, it will be clearer for all to see who are the users of our world class infrastructure enjoying our world class roads, tarred thick, smooth and nice as the facial foundation of the office ladies who chope their seats with tissue papers.

Ok you got my point. So we have surgeons separating Siamese twins, geniuses who transplant livers blindfolded while juggling his handphone with his tongue, physicians who can perform miracle healing to foreigners. In short, WORLD CLASS medical system. Well, if someone tells me that, I will not dispute it at all. Simple because, I do not know a shit about any medical system anywhere in the world. Let me give you an example what kind of noob I am.

I remembered asking my friend Grace, working as a nurse in Perth for more than 4 years, about how her hospital class their wards. She wrinkled her face and gave me a puzzled look and retort, "When there is bed, we give it to the patient lah! There is no class A, class B or whatever crap." That night I consulted my good friend Tucky via whatsapp and told me about my conversation with Grace. He exclaimed,"Wah lau, you don't know class system only applies to Singapore? Which cave were you hiding in?"

Hmmm.

Let me share a tale of a very unfortunate commoner in Singapore. This account may be true, but not a representation of the general Singapore public because he may very well just be an unusual suay kia.

Dermatology

The first time Suay Kia saw a specialist was during his NS days where he developed a skin condition he had never encountered in his life. He was referred to a skin specialist in Tan Tock Seng Hospital. He was diagnosed with Eczema at the back of his knees, all over his neck and the of his scalp. Very often the affected areas oozed clear fluids. It was extremely itchy all the time. He was prescribed steroid creams after the end of each visit. The specialist said there was no cure for this condition and could not offer any other solutions than steroid creams. After 1 decade of suffering from Eczema, Suay Kia decided that the steroid cream made the wounds swell with increased itchiness and decided to stop using it. Till today, most of his affected areas disappeared except for the scarp, which may be plaguing him to his death bed.

Podiatry

Suay Kia was a avid soccer player in his youth. Due to accidents, he injured both his ankles on different occasions multiple times. He was referred to the specialist in SAF school of medicine where he was given painkillers and ultrasound treatment each visit. The condition didn't improve. Eventually his ankles were treated by a random Chinese sinseh from somewhere and recovered.

Orthopedic

Suay Kia was pretty good in his chin ups during NS days, clocking up to 25 before he hurt his shoulders. At first it seemed like it was a normal neck sprain. But he got worried as he kept injuring the same location very often in his later mandatory chin up sessions in the army. He was referred to the Orthopedic at 'K' clinic of Alexandra Hospital where he underwent 2 years of physiotherapy and muscle gel prescription. After 2 years of faithful belief in the specialists, he got fed up and demanded for a serious review of his problem. The specialist reluctantly ordered for an MRI scan on his neck. The result revealed Suay Kia suffered from a slipped disc in his cervical vertebrae. The specialist hurriedly wrote a letter to the SAF MO to have him downgraded at his third year of reservist.

Gynaecology

Later in life, Suay Kia was married and got his wife pregnant. Their excitement soon turned into a nightmare with KK Hospital. Read about it here. [link]

Urology

It's another hit and miss case for Suay Kia [link] who was told his blood in the bladder was due to exercising.

******

So higher class, better medical treatment? Mean testing? Let me tell you, brothers and sisters. I don't care how they coined it. This is so wrong. They can commercialise whatever they want and fatten their pockets but medical MUST be left out of the game. Who's gonna pay? Who's gonna pay? The morons in white will scream. That tells you a lot about millionaire ministers asking the citizens the question they are paid to answer. As a citizen, I don't give a fuck how you do it. You can jolly well shut off all the thousands of street lights at night to fund a free medical system for every single Singaporean to receive an equal access to excellent medical attention if you need to. I am very sure there are much less radical, sustainable solutions. The fact is, the government does not have the intention to do this at all, not because there is no solution to support it.

So do we have to go to exclusive doctors to get ourselves probably healed? Is it Suay Kia's fault for putting faith public medical practitioners? If you just a commoner and not a rich Indonesian, what kind of medical standard will you receive? A doctor is a doctor is a doctor. But no so in world class Singapore. Is that the fate of the Singaporean under classed to receive medical attention as cheap as their lives?

I sat down and had a heart to heart chat with my buddy in Singapore via whatsapp. The topic was of course, about my cancer problem. Before long, we were joking about it. Good buddies joke about anything under the sun, probably even to our death beds. They say if you live life without a buddy like that, you would have live for naught. I'm a lucky man.

Bit by bit through the conversation, I recalled what happened to me in the last two years and I began to realise how long I had been ignoring the messages from my body. The conversation did lead to a surprising finding:

There is a very high possibility I had cancer even before I came to Perth.

Some of my friends back home may recall about three weeks before I left Singapore on a gloomy day of 17th November 2011, something shocking happened to me.

It was a Monday morning. I was preparing for work as usual. When I made my customary morning pee in my sleepy stupor, I felt something very unusual..erm.. down there. It felt totally blocked as I was flexing the muscles of the bladder to push urine out. I maintained the pressure, careful not to over exert. Then the horror happened. The pressure gave way and I heard a hard splash.

When I looked down, it was a total crime scene. Blood were splattered everywhere randomly. There were thick dark clots among the streams of viscous fresh red blood. There were a considerable amount of blood landing outside the toilet bowl. I was totally awake by then. Who wouldn't? Amazing, I remembered I finished my urination calmly, watching my full fresh blood flowing out until the end. It wasn't a case of blood in urine - I was literally pissing blood that morning.

Before long I was in the polyclinic, drinking a lot of water all the time and checking the state of my urine while waiting. It was considerably more diluted. Over a few rounds, I managed to get the urine lighted tainted with blood, a far cry from the horror scene earlier morning.

******

My job for that last two years preceding that incident was rather hectic. I was working in a typical local construction company in Singapore. We worked pretty hard. 6 full days per week, typically 10-16 hours per day. There was a memorable (unfortunately in a bad way) period of 3 months I had to sleep 3-5 hours a day on the project. It was an A&A project in Raffles City, where we built a 30 metres truss 4 levels above a fully operational shopping complex. Due to the high risk of endangering shoppers walking obliviously below, our work normally started after 2300 hrs and ended around 0600 hrs. The project manager from the main contractor would began spamming my phone by 0800 hrs the next day. Very often, I had to find sleep in-between the job, many times at the back of my faithful Renault Kangoo. Life sucked. Thinking back, I would rather wash the plates. If only that $3,000 dish washing job was available back then. Fuck.

That wasn't the start of my bladder issues. There were no shortage of toilets in Raffles City. Unfortunately unearthly sleeping patterns took a significant toil to my health. On top of that, due to the nature of work, I ate terribly. Very often we ate dinner when it was time for supper. We skipped many lunch and ate a lot of processed snacks and drinks to fill the stomach and carried on work. Over time, the body suffered.

The next few projects were typical construction sites. The Marina Bay Sands (MBS) project was notoriously challenging, where relieving ourselves were concerned. There were no toilets in the site. As we were building the ground level shopfront of the entire podium, very often we needed to walk more than 400m (including detours and obstructions) to reach the site office, where the only toilets were. As we concentrated on our jobs, very often we pushed our bladders over limit. That could be the beginning of the problem. We spent 10 months in MBS.

The glorious blood pissing ceremony marked my 2 years with my ex-company. I was already serving my notice by then. At the same time, 1 month before I submitted my resignation, I took up jogging due to the encouragement of my friends. I thought it was paramount that I must rebuild my health, after I felt the toils of the job had taken on me. I could clearly remember how unfit I was when I began. I couldn't even finish a simple run of 1km. With perseverance, I struggled but managed to build up enough stamina to run my first 5km in many years. On a special rainy night, I decided to grit my teeth and push myself to a mental limit. That night, I laid on the running track of the ITE West at Choa Chu Kang, absolutely exhausted after the completion of my 10km run. I remembered looking up to the sky and saw a few small stars. I could recall wishing if only life in Singapore could be like that every day. That there was a time to work, a time to play, a time to rest.

There wasn't stopping me after I hit my first 10km. I began to increase my run and eventually ended up doing 15km twice or thrice a week. It was an enthralling experience for a health wreck a month or so ago. The general weight loss and muscle building was welcomed. What made me happy was that I regained my sharpness in the mind and interest in life. That was too late though, as far as my bladder was concerned. My last 15km was on a Saturday, 2 days before the blood piss ceremony.

******

The GP in the polyclinic was not comfortable with me. They were accustomed to coughs, flu and fever. Not blood pissing. So I was referred to a specialist in NUH immediately. Before long, I was sitting down waiting at the urology specialist department in NUH, with ah peks sitting alongside looking curiously at me. Yeah, why? Young man cannot have peeing problems? Blood hell, si ah peks.

The young doctor looked at my case and got me to do an x-ray. When I returned, he told me based on the x-ray, he could not find any problems.

"What were you doing before you have this problem?"

"I ran 15km two days before. Any problems?"

Pause.

"I think it could be the run. Long runs like this could cause the bladder walls to be damaged due to constant rubbing and that could result in bleeding. As your bleeding has stopped completely, there shouldn't be any cause for alarm."

That was the end of my treatment in NUH.

A few weeks later, I noticed a little blood in my urine but it went completely clear the next morning after though I completely stopped running at the advice of the specialist. I put it at the back of my mind and enrolled in the crazy final weeks before our migration to Perth.

We could have picked it up in Singapore, but we didn't. I could have peed in a bag instead of walking 400m to the nearest toilet. As my friend Stephen said, “早知没黑衣” (In hindsight, there would be no beggars)

We knew very well what happened in the next 8-9 months. We were helpless. I had no friends, not a single soul in Perth. My wife was 5 months pregnant. We had limited funds to get by. The survival instincts took over and I picked up any work I could find. Metal grinding and cutting wasn't that bad. On hindsight again, the hours didn't do my condition any favours. Wait - did I think I had a condition? No. The specialist in NUH said I was fine. The hazards of the job were mostly physical. The two eye surgeries to remove metal splinters from my eye was frightening, but it went well without any side effects. A welding accident left a permanent 3 inch scar across my right thigh. That too, didn't impair me in any way. The constant vibrations on my arms did cause massive damage to the joints of my fingers that still hurt slightly till today, though it seemed to me they have gotten better by the months, as compared to the days I couldn't even clench my fist without pain and had to sleep with hands below my head so I would not move my fingers accidentally in my sleep. These were superficial. They paid me well for the trouble almost 89k per annum for the trouble.

Why were we paid decently even for just being a trade assistant? That amount of money included overtime. There was an obscene amount of overtime we were offered. It was optional but I went head on with it like a raging bull, with the birth of my first child as motivation. On top of that we were paid 20% more than the day tradies because we were working that 3.30pm to 2am shift. Two critical factors here probably did my condition no favours. The night shift and the working environment. Despite the mask and filter I wore faithfully every night, I noticed it was not impermeable. I could recall washing the insides of my nostrils every night to clear the sooty mess. Being hungry at 3am in common. I would be filling my stomach with junk food while waiting for my hair to dry. More than half of the posts of this entire blog came from nights like those. When I had my fill, I went to bed immediately.

I have Alvin to thank for the lead that linked me to my current job. Micky probably saved my life by strongly advising me to take a pay cut and take up the current job, which I was hesitant at one stage. Other than less money, there isn't anything I can fault about this job. This was the best job I have ever taken up so far in my career and the only job which I can truly declare I enjoy tremendously. My hours are humane now at 7am - 3.30pm. I'm contented and happy.

When one is sick, there is no one else to blame but himself because it is everyone's responsibility to take care of his own health. Sure, if the specialist in NUH raised the red flag, it would be jolted me to put full attention on my health much earlier. My tumor would have been destroyed by having a suitable diet and rest before it escalated to this stage. Ultimately my health is my business and I am taking full responsibility for the problem now. I believe with awareness, conviction and the willingness to take up responsibility, I would be able to reverse my destructive health habits and restore it back on track.

Yesterday was pre-admission assessment. About time, about time. I felt something in my bladder again. It was of course our good friend, Mr C. He was back, seemingly after I relaxed a bit on my diet and began taking things like brown rice and noodles. It looked like there could be some truth in starving cancer cells by removing carbohydrates and sugar completely from the patient's diet. I did exactly that during the first 2 weeks and actually felt better. I thought it was imagination then but I was wrong, it worked after all. For currently I felt like I was back to square one, the pain and urine flow rate was back to the week I was diagnosed.

Even though surgery is 6 days away, I would resume the strict diet I imposed on myself that made my condition seemingly better. It would be a second chance to test the theory, if affirmative, will be very much an indication how I should be eating for a long, long time after my surgery and subsequent treatments so as to keep cancer at bay. I was told by the doctor during the assessment yesterday that bladder cancer has one of the highest chance of re-occurrence. That meant this would be a battle for life, unfortunately. This is a very important fact with serious implications on matters. Remember that, we'll come back to it.

Both doctors I met were pleased with my condition. (I.e. I would be unlikely to die on the operation bed) Thus, we agreed that the surgery would take place as planned. The guys at Royal Perth Hospital will perform the Transurethral resection on me. They didn't describe the process to me. All that mentioned was that it is going to be a simple and fast operation which will not span more than 1 hour from end to end. But I knew what I am going to go through.

I won't elaborate much. This picture tells everything. Looking at it shrinks my balls - even if I'm not the one undergoing the procedure. Unfortunately, I am. So you can be sure they are hiding tight in their bags right now as I am typing this. Yeah, I had been told by so many people I would be fast asleep when they do this so I shouldn't worry. Trust me, you won't appreciate anyone piercing a probe right through your wee wee anytime, sleeping or not. But what's gonna be done, gonna be done. Just don't leave anything that doesn't belong there when you're done.

I was required to report to the hospital at 0630 hrs. Cool. I like that arrangement. For some reasons, I don't want to see the sun at all on my way to the hospital. I hope I do when I wake up.

I received a good amount of callouts from friends and family to consider a return to Singapore to treat my affliction. The advantages include a possible shorter wait to get treated, lower cost, higher quality of treatment, family support and Jen could rejoin the workforce because my mother would be able to take care of Albany in her absence at work. In short it would look like either of these: return to Singapore - get treated - return to Perth and the variation: return to Singapore - get treated - stay there for good. That would be discussed on a later post.

A day after my diagnosis, we moved from our previous place in Gosnells to our current cosy abode. We decided that the rental increment was too high for our liking, bit the bullet and moved to a smaller place. I would be the less common patient who didn't mope for a couple of days. Couldn't. Circumstances didn't allow me to. We made at least 9-10 trips on Goldilocks in full loads and 1 trip with the company ute for the big items - with Pat and his elder son Jason lending valuable hands on Wednesday evening. Moving our fridge and bed base up the second level through a narrow and angled stairways was almost an impossible task. We cracked some plaster on the wall doing so.

I slept like a dirty torn rag that night. I was absolutely knackered in all sense of the word, in every aspect of my self. It was fortunate that my parents were around to take care of Albany, for which all the actions would have been impossible. That highlighted the point that my sister made. If I were to move back to Singapore, I would be partly relieved of taking care of Albany so I could concentrate on treating myself and that Jen could find work without the reservations of leaving Albany in a child care.

The new place, lovely as that, looked like a war torn zone the next morning. There were lots of work, I mean LOTS, to do. It would probably take us until Winter to get everything into place and then fully settle in. There was no time to worry about that because we had half a day to fulfill our cleaning obligations in the previous rental unit and return the keys at 1600 hrs that day. I had to hold my breathe to avoid breathing in too much fumes from strong cleaning agent. There were too much to do, too little time and we were still suffering from fatigue from the entire week of packing and the previous night of moving. We made ourselves to the finishing line at East Victoria Park almost right on time, zombified. Because dead is too fresh to describe that kind of weariness.

We strolled out of the estate management company and strolled along the lively Albany Highway along East Victoria Park. We decided that we had all but 30 minutes to find a rental car before the end of the working day the preceded a much anticipated long weekend with both Friday and the following Monday being public holiday. The long weekend we were supposed to go on a trip.

Amidst all the chaos, we had put our Albany trip entirely at the back of our minds. The trip was planned last Summer with a small group of friends. Everyone was looking forward to it, including ourselves. Perhaps until I received the bad news on my condition, that made me the exception. Still, I thought the getaway would be beneficial for me after all the euphoria.

Rest. All I wanted was rest and nothing but rest. Albany was as beautiful as before, despite the cloudy skies shielding the ocean from looking its absolute best. No matter. The long weekend probably brought a lot more traffic to the little sea town than I preferred but the place was still as serene as I remembered it. We did a customary run to places of interests as a few of us were first-time visitors to Albany. We spent every other time doing nothing, strolling with little Albany in our arms and introducing her to animals nearby our stay. It was awesome and we loved it. The air was untainted and the weather was perfect at mid twenties in the afternoon. It was criminal to stay for only 3 days 2 nights there. The next time we manage to persuade ourselves drive over 400km for a getaway, we will love to stay much longer, keep attractions run to a bare minimum and simply live life as it is.

Back to the street of East Victoria Park, our strolls slowly took to a jog after we realised there was a car rental shop just 400-500m away from the estate management company we just left. Jen giggled and soon we began to laugh as we raced to the car rental. It had been awhile since we spent a little time without little Albany around us, as we left her in custody of my mum while we tried out best to complete all deliverables of that day. My mind took me back to 6 years ago where I first came to Perth and both of us explored the streets of Perth with a pure heart and nothingness in the minds. I felt younger, as we sprinted the remaining distance of our mock race. The kind of thing we would do in the past. We got what we wanted before the shop closed and drove back the red Hydundai i20, slightly undersized but just enough to get us comfortably to-and-fro Albany.

Sister's advice was as sensible as always, but it requires a lot of thinking about. It is a simple solution but not easy, not easy at all.

I had professed my love for Autumn many times in the blog. She was always my gushing favourite. Alas, the love wasn't mutual. I had a car accident last Autumn. This time round, I have cancer. What do I need to do to make Lady Autumn smile at me next year?

I'll stop killing flies this coming Summer, promise.

The second month of Autumn, April, was a bad month to break uneasy news to anyone. I noticed it didn't matter who and how close the person was. I was diagnosed with bladder cancer around 25th March. The first people told me early April Fool jokes weren't funny. So were post April Fool jokes. Even in mid April, I was warned not to play silly April Fool jokes way past the permitted date. Oddly, I seemed to be the person who took my own bad news calmly.

I could emphatise. If I was in those shoes, I would have done the same. I would have snared at my friend for a bad overdue April Fool's joke, fumbled for the some niceties to reply when I realised it wasn't a joke, sent them, shut off my phone, ran 500 metres and threw it in the river. Nobody relishes bad news. Before long, I realised it was a huge mistake to tell anyone at all. I could have kept it quiet, gotten cured and moved on, without alarming anyone. Soon, the mistake came back to haunt me. The initial sympathies and concerns towards me were soon replaced by disbelief and then eventually anger at my disability to give an accurate update of what was going to happen to me.

One week, two weeks, three weeks went by. I was under pressure as disgruntled friends kept asking for updates. Even my boss bugged me every single time he saw me (he doesn't turn up for work everyday).

"How can you be so calm?" the boss exclaimed, in disbelief.

"If this happened to me, I would be literally breathing down their necks twice or thrice a day or as many times as I needed to. You Asians are truly patient and too nice about such things."

He held his hands up quickly, "Hey, I meant that as a compliment." The boss was the only Caucasian in the entire company and he hired every single Asian, including myself. He married an Indonesian woman and raised his four step-kids as his own. My boss wasn't a racist - and I knew where he was coming from. I knew where everyone was coming from. The problem was there weren't updates because there weren't updates. Each call to Royal Perth Hospital yielded the same result. Jen or I would be told there was no dates, the specialists would required time to prioritise their referrals and schedule them accordingly, I was on the "waiting list" and that was the system the hospital operates. Each time, the advice given was the same. If I couldn't wait, go private or the emergency. That was that. People expected more drastic action from me than accept and respect the system. Yeah, I could burn Royal Perth Hospital down by making a trip to Bunnings to get my supplies, or play act at the emergency department to force them to see me but I reckoned I would be better off concentrating on knowing more about my illness each day and focused on suppressing the cancer cells within me, if I couldn't kill them.

My initial reasoning of breaking the bad news to close friends was that I thought it might be unhealthy to keep things inside and that if I wanted to start fighting cancer, I needed to accept my opponent instead of pretending it didn't exist. I didn't want to live a lie everyday, rejecting food and turning down BBQ invitations with the need to think of a new excuse each time. I thought it would be sensible to have people around me to remind me not to eat certain food harmful for my situation if I picked any up, rather than offering them to me without knowing I shouldn't be touching them at all.

That loop went on for three weeks. A couple of friends went livid and there seemed to be insinuations that I was not taking my life seriously, that I wasn't a responsible man, not sparing a thought for my wife and child and parents and the lemon tree next door. Every journal about cancer that I read recommends a healthy state of mind for cancer patients, for the best chance of recovery. I couldn't help but notice the effect of the amount of unnecessary stress my contacts were piling on me. Thus, I decided to heed my inner voice and shut off communication regarding this issue.

So why the contradicting move to return to blogging and practically revealed it online, where those who have no business to know about my condition and some whom may even pop the champagne at the good news, lurk? I see it pointless to hide from folks who are immune dettol.

I write, as the religious prays. Each post renders my mind the clarity that I need now, the way it did for me through my darkness nights when I came to Perth with little money, no jobs, no friends and no knowledge how Australia works. Along the way, I lost my bearings. I began to write to an audience and eventually I hated that, stopped blogging and never return to it for a single look for months. This time round, I hope to stay on track and focus on writing to myself, writing for myself.

I have to agree that no matter where we start, the more we write the better we get and vice versa. I feel rusty. I am rusty. Not that I was any good to begin with but you know, I feel worse now. Every now and then, I was asked to continue writing stuff by a couple of friends and a couple of strangers from the internet. Not once, I obliged. In fact, I didn't even take a look at this blog for months - a far cry from the days of blogging almost every single day over 400 over days consecutively. I didn't even reply a single email sent to asingaporeanson@gmail.com though I read every single of them. To me, a decision to stop is a decision to stop. I have always been clean when it comes to these. It's all or nothing, that's how I live my life.

Yan Chun deserves a post. It will be criminal to deny her one. She have been tagging me in facebook calling me her favourite blogger for too many times, for too long. I never could tell if it was a joke, sarcasm, tease or an unlikely fact. No matter. Yan Chun was probably patient enough to coax Axl Rose to do a gig with Slash, if you know what I mean. At the same day, Gintai - my old blog buddy in Singapore - reappeared in my whatsapp window since ages to check if I died like feedmetothefish.

"Not yet bro, but I've cancer," something along that line, was my reply.

*expected pause*

*expected big reactions*

Gintai. When I return to Singapore for a visit, I wouldn't miss having an one-on-one chat with this man.

"Create a blog and let us communicate with you," Gintai insisted.

I promised him I would. Unfortunately, not quite fulfilling the promise to a T. I do not have the energies to create another blog. So yeah, I'm still writing stuff here. No. I don't want to communicate with my friends via blog comments anymore. My friends will find a way to reach me if they needed to. Like Lanley, who did exactly that without a clue how and where.

Back to Yan Chun. Seriously babe? Favourite blogger? We're talking about a blogger who doesn't even bother to edit any of his shitty grammar and spelling mistakes in his post. I like your sense of humor. Hope to catch you in Singapore too.

I stopped blogging from god knows when I felt there because there seemed nothing else worthy to share. If there is nothing I can contribute, be it in some form of experience that others can refer to or fresh perspectives that shift mindsets, there isn't a point to add noise to the heavily polluted online world of today.

This isn't about migration. I do apologise for folks coming to this blog to seek a way into Australia. I understand it is becoming increasingly difficult to gain access into the country. There is a great immigration history behind Australia and the country has not closed the door to migrants but immigration guidelines are being refined each year to ensure Australia gets a good share of quality migrants as much as possible. As a result, it is tougher to get in by the year and the government of Australia makes no apologies about it. That also meant I have lost track of the latest guidelines, effectively rendering the blog useless as a technical guide regarding migration application. I foresee only two possible scenarios to restore the blog to its former glory, as far as migratory advice is concerned;

1) I read up about the latest migration rules and spoon feed wannabes like I did before. This scenario is highly unlikely to happen unless I attain the same level of boredom as I did when I first tried that.

2) I go through a course and become a migration agent. Then it becomes my business to recite migration details to impress you. For those who knows me, they know that's no chance in hell it'll happen.

There. So you know you're at the wrong place if you are looking for migration information. A year too late, buddy.

I pray you do not get cancer in the future. But if you do, remember this blog and come back to read it. You may benefit from my experience the way some did when I bared my heart to share my entire migration adventure from Day 1. I was diagnosed with bladder cancer three weeks or so ago. And I plan to share it with the same intention I had - to share the world of cancer according to my mind and heart. Hopefully, no one reading this needs the information. Thus hopefully, no one reads this anymore. For the unfortunate ones though, let's hope my experience helps in some way if I do well or serve as a warning, as a bad example of dealing with the condition should I not survive the battle against cancer.

There are so many misconceptions about cancer. I am still figuring out the facts from the myths. One thing for sure, it is a mysterious condition. After decades perhaps centuries of medical research, doctors could not confirm the causes of cancer. Neither could they come out with a effective cure. As a result, there are so many school of thoughts on dealing with the condition. As raw information funnels into a new cancer patient, it can be overwhelming.

As much as it is difficult to point out the type of diet, exercises and lifestyle that may help suppress or even cure cancer, it is probably harder to figure out the cause of cancer. As we know, it may be wise to address the problem at its source instead of probing around the nooks that doesn't quite matter.

As far as my case is concerned, it is almost impossible to identify the cause. It may be convenient to point the finger on my sudden move from Singapore to Perth, especially the toughest 8 months of my life working night shift in an unforgiving polluted environment and coping with a newborn baby in the middle of this period. It is however, not that simple. There were far more to it than that, as I sat down one day to reflect. It could very well be traced back as far as my final few years in Singapore. It might very well be a combination of factors. A perfect storm.

Like I said, it seems to easy to point a finger at something I did or didn't for my condition. That's pointless to do for now. It's as silly as saying I got cancer because I blog. After all, before I began blogging, I didn't have cancer. Ok this may be exaggeration but that is the kind of wild throw that I have to deal with from people. If we wish to bring ridiculous to a new level, why don't we say I have gotten cancer because I stopped blogging.

And so here's the cure. Blog away.

A Singaporean In Australia

Past Rants