Wednesday, September 26, 2007

Chemo Comparison

I had one chemo treatment in Sydney, Australia during our family vacation. I just got back to Singapore and had another chemo treatment today. What a world of difference in the two experiences!

The chemo room in Sydney was warm, lively, buzzing with activity. Patients were busy reading or chatting with their chemo buddies, while nurses scurried about calling out greetings to patients and engaging in friendly conversation.

The chemo room in Singapore was cold, quiet, and full of sick-looking people. The patients were all asleep. This may be due to the fact that the Singapore doctor is giving all her patients drugs that knock them out, as she had been with me.

I learned in Sydney that I’d been getting seven drugs to control side effects, none of which the oncologist there thought I needed. So when I went for my chemo today, I asked to have my chemo without these side effect drugs. For the first time, I was awake during my chemo and left the doctor’s office feeling awake and energetic instead of groggy and drugged.

I think the Singaporean approach is to overmedicate just in case a patient develops side effects, while the Australian approach is to wait to see if a patient has side effects before they start prescribing drugs. I’ve had no side effects. I ran seven kilometers tonight without any problems. In fact, it was my fastest time yet. No side effects. I’d been taking seven side effect drugs that I didn’t even need. That’s about S$500 worth of drugs each time I had chemo.

That brings me to a big problem with doctors and drugs in Singapore. Here, doctors dispense the drugs they prescribe. So the more drugs they prescribe, the more money they make. That kind of collusion would be considered illegal in the U.S.

The nurses in Sydney were more knowledgeable, articulate, and communicative than any doctors I’ve had in Singapore. In Singapore I have to fight for every bit of information I get. In Sydney, the nurses were amazingly well informed and very good at explaining every aspect of my treatment with me. I’ve gotten answers to questions I’d been asking my doctor for months without getting clear responses.

When a nurse came to me and introduced herself to me, I hesitated for a second before responding because it was such a new experience for me. Since my diagnosis almost two years ago, no doctor, nurse, or technician in Singapore has ever introduced themselves to me. A simple “Hi, I’m so-and-so. I’ll be doing this procedure for you today” is something I’ve never heard here in Singapore.

On the other hand, the oncologist in Sydney was very impressed with my scans. I don’t think she’d ever seen a whole body MRI before. So technologically, Singapore is ahead of Australia. But in the human touch, Singapore is greatly lacking.

Where does this leave me? As my situation deteriorates, I’ll be getting into more complicated drugs and surgeries. The thought of going through another surgery in Singapore, especially something as risky as brain or spinal surgery is scary. Not that the doctors here aren’t qualified and skilled, but I can’t imagine having a satisfactory conversation with a doctor here about the surgery or after-effects. Not being able to talk about this stuff with your own doctor due to communication difficulties adds so much stress and worry to a situation already loaded with anxiety.

My choices are to either move to Australia for the remainder of my treatment or try to change things here. What’s that serenity prayer… Give me the serenity to accept the things I can’t change, courage to change the things I can, and the wisdom to know the difference. Courage and wisdom, I can muster. Serenity is too tall an order for me.


Mel said...

Welcome back, Shin. I've missed you (electronically that is). I hope you had a great holiday. That's amazing - I can't believe you were having all those additional drugs that you didn't need. I guess I was having them too when I was doing chemo!! Thanks for the info - if I have to have chemo again this will be great information to have. I go to the chemo unit at Gympie hospital to have my port flushed, and in the same way as you have noticed a vast difference to Singapore. They have lovely women who are volunteers to chat to the patients while they are having chemo. They even had 2 dogs in there to cheer people up the last time I went!

Alison said...

Can this piece be adapted and published in the Straits Times please? Can you go on May Lee's show? The media can help you change things, if they are willing here. But will they have to be changed in order to foster change? If you move to Oz I'm coming too.

Anonymous said...

Hi Shin,
Thank you for this and I will send it to my oncologist - who I must say was very helpful at NUH - but I do believ if anyone can make a difference in the way Singapore manages these things she will. Good luck to you from the bottom of my heart. Helen

Mel said...

Sorry Shin, forgot to ask - did you get any new opinions on your cancer or the proposed treatment in Oz? xxxxx

Shin said...

Alison, I do indeed plan to write to the Straits Times about the lack of communication and interpersonal skills in the medical community. My case is nothing compared to the traumatic experiences some of my friends have had. There are two issues I'd like to look into: 1) How to get training for medical professionals to make them better communicators and more sympathetic carergivers. 2) Why doctors are allowed to make money off the drugs they prescribe, a system that can harm patients with overmedication. If anyone has any advice on how to tackle these two problems, please let me know!

Helen, I'm sorry I'm not sure which Helen you are. I know a number of Helens. Can you identify yourself to me so I know who you are? I'd love to know who your doctor is as well. Maybe she can help? And thanks so much for your encouragement.