A Brother's Love - My first liver transplant

The first time I met Mr E in National University Hospital was on the day before he would take the biggest risk of his life. I was struck by this friendly and cheerful giant. At over 180m tall and more than 100 kg, he clearly towered over me, the unsuspecting tiny surgical registrar. I noticed how much he engaged himself in the conversation as my consultant surgeon explained to him again about the entire procedure, never mincing a single word on how things could go triumphantly right..or even tragically wrong.
 

            He is one of the healthiest person in the room and we have to be absolutely certain that it. After all, we have subjected him to almost every single laboratory tests and imaging modalities available in this medical centre on a young person who would never need it under normal circumstances. However, Mr E is not a normal person..in fact, he puts all of us to shame for doing something remarkable for his brother. He is giving up more than 70% of his liver although he absolutely doesn’t need to do so. All for the love of his youngest brother, Mr A who could die if he doesn’t get a liver soon.

            What drives a person to this kind of sacrifice? As I prepared myself mentally and physically for the exciting yet arduous task of a living donor liver transplantation on a beautiful quiet Saturday morning in NUH, I asked myself whether I could have done the same for my siblings or loved ones. Why are doctors willing to help be part of this big risk? Why are we not saving more lives this way? Why?

            No choice. There is simply no choice for people like E and his brother. I can only think of these 2 words. Between life and death, they decide to seek life. They travelled all the way from Middle East to Singapore in order to seek the best that liver surgeons, hepatologist, radiologist immunologist, etc could offer.

If only more people step up and say, “I am willing to be an organ donor shall I perish and I am suitable to be one” or “Please doctor, my loved one may be dying, but I want his death to be life for many others”. In dying, we can find life but why are people so unwilling to do so. As many of us search for answers and dwindle on longer and longer based on indecisiveness and fear, courageous people like Mr E and many others embark on this path less travelled – living donor liver transplantation (LDLT). A path fraught with legal red-tapes, financial constraints, personal sacrifices and even death for both donor and recipient. It's never a path taken lightly or without due consideration.

Organ transplantation is not new in this region. In fact, Human Organ Transplant Act (HOTA) has been around for at least 2 decades in Singapore but the numbers of transplantation has been dwindling abysmally over the years. The amount of liver transplants done in this country this year is woeful and augurs poorly for the future. We have less than 10 cadaveric transplantation cases countrywide this year, which was the bread and butter of transplantation surgery.

 As a result, most of the transplants had been the extremely high risk LDLT. This is in comparison to some other Asian centres, like Korea and Japan where it can be an average of 350 cases per hospital per year. This means that there is at least one transplant going on in the operating theatres each day, every single year in these hospitals.

 The saddest part for me is that many people hesitate to donate organs of their dying loved ones due to many reasons. My head spins when I hear of many creative, incredulous reasons why a person in intensive care cannot donate their organ. There are no logical, moral, religious and logistics reasons not to donate organs in this country. My summary of all the excuses so far are captured in 2 adjectives: unwillingness and ignorance.

Every case of transplantation is an exciting journey upon itself but not every transplantation stories have happy endings. They almost never receive the publicity or fanfare they deserve. During my first experience with a liver transplant surgery, my heart was beating in joy and humility for what I was about to experience – it’s literally sharing the gift of life from one person to another. In my little mind, it was one of the best, jaw-dropping, awe-inducing demonstration of surgical knowledge, dexterity & skills, inter-disciplinary teamwork, medical camaraderie and top-notched, dedicated support staff.

This act enables someone who was constantly ill and dying and transforms them into a real human again. They will no longer be dependent on machines and doctors for long term. Although each recipient may face an armamentarium of medicine in the beginning, they will soon be weaned down to one or two maintenance medications and minimal follow-ups with doctors.

 

What are the highest achievements of a civilization? What is the marker of a successful, egalitarian society? It’s when we stop looking inward and start to look at the common good. It’s when we see our struggling, suffering comrades and in love, extend a helping hand. We must continue to support the transplantation program in this country before it becomes a dying art, a fossil, a relic of past glory.

 

As of today, Mr A is still resting in intensive care while Mr E is carefully nursed in another high dependency unit. We pray that these 2 young people will recover soon and return heroically to their country within 1 or 2 months.

Highlights from the land down under Part 2 : Urban landscapes

So, back to Sydney (I know I have been pretty inconsistent with blogging but hey, with accumulated sleep of 30hours over the past 1 week, I have been really busy).


Walking around in Sydney was very effortless and enjoyable. There are interesting sights and good food everywhere.

The sun was out in full force despite being the height of winter. Just a simple cardigan sufficed. There are lots of sporty Australians running around in shorts and light tops.

And of course I took plenty of pictures around the Sydney Opera House area. Pretty ain't it? There is a cool cafe/bistro within the compound while shows/musicals/performances are held weekly.

Time for some cardio sessions in Sydney? It took me a few tries to perfect this star-jump!

The Opera House from across the bay. This is from the bridge side. This is NOT taken with the proper lens (as I only travelled with one all-purpose lens).

This is the Rocks area - the most historical area in Sydney whereby the first few hardy English people first landed and established a 'convict' colony. Plenty of shops, cafes, museums and visitor centres to keep you occupied while the weekend markets are well-known for offering extremely good bargains.

Dusk at observatory hill. Notice the sunlight piercing through the clouds. Perfect 'romantic' moment for the couple there? However, on closer glance...it was actually 2 guys/buddies having a chat about life!

Another view of the Harbour Bridge from Observatory Hill. Nightfall arrived around 430-5pm during winter, thus limiting the hours that we could walk about. Anyway, time for dinner!

to be continued....

Highlights from the land down under Part 1

Prelude..

Despite my delusion that I'm actually a celebrated travel-photojournalist, I've only been to 2 continents my entire life. Asia and Europe. When the opportunity to hop down under for a meeting in Australia, I was ecstatic excited lost for word. I've long wondered about life in the Southern Hemisphere - winter in July, gazing at the Southern cross, seeing a kangaroo/koala/platypus/Australian in their natural habitat and catching a glimpse of the famous Outback. The list goes on.

So, the moment I stepped onto the Qantas flight, I was very happy just because there is a skycam. It's so interesting seeing the plane I'm on departing and landing. It helps having a running commentary about 'flying' from the person next to you. Cool...

Winter is surprisingly mild in Sydney...according to my irritatingly-immune-to-cold-weather friend R, who walked around wearing a T-shirt while I was shivering my light jacket. I think it was the cold, biting wind which I couldn't adjust to...living in the eternal sauna-like Malaysia/Singapore almost my entire life. However, I began to love the cold after a while, especially after a warm meal.

Talking about meals - food in Sydney is superb. Aside from the fast food @ Oporto on the first night (yeah, we were THAT tired to notice), each meal in this exciting city seem to be really good. Dinner @ Mazzaro, courtesy of our sponsors gave us an early inkling of what to expect in the following few days. It was yummy!

My main course was this pan-fried salmon with crackling skin ( I don't know how they made this impossibly-crunchy dish) that reminded me of the best roast suckling pig back home. Dessert was a trio of ice-cream and I poached some of poached pear from my neighbour. Finally, I'm living my Masterchef Australia dream. Hooray!

What best to accompany such gluttonous dinner/wine session but a quintessential jaunt down Elizabeth Street to the nearby Sydney Harbour area. Weather was superb as we gape at the pretty bridge and the Opera House. Nice...



to be continued

House @ Dempsey

After church service today, SW and I decided to go to Dempsey since her parents are in town. Having a friend who can drive really improves my quality of life (of course, I think I should consider getting some wheels myself, but nonetheless, still waiting for prices of stuff to drop). She suggested House as PS cafe was packed to the brim.

It was a sunny and relaxing Sunday - having a few hours of rest while oncall helped my mood as well.

It is a pleasant cafe right next to a secondary jungle, which I heard belonged to a certain Malaysian royalty, therefore undeveloped.

We ordered different kinds of food - pasta, pizza, fish and burgers. I remembered that the food was quite good. I wasn't disappointed.

My pasta - which is the chef's favourite - called Bay Prawn Cappellini was gorgeous. I loved the fresh prawns, fresh taste of leek and also the birds eye chilli scattered sparingly. The other dish ordered by my friends were good too. I enjoyed the truffle-infused fries and also the thin-crust pizza (so thin, it was like pappadam!). SO will I come again? Definitely. Anyway, today's outing marked the first time I ventured out with a 'heritage' camera handed down to me. I kinda like the pictures compared to my usual digital camera. Can't wait to try it out in Sydney soon!



What happened to me?

Someone asked me: did you stop blogging completely? I think yes, for the past 6 months...because of various reasons. Mainly, lack of motivation and heavy inertia. Life on this island is so hectic and draining...to the point that I lost interest in most things I love, including running, church-related activities, studying and even relationships. I felt like I just couldn't go on as before. It was just humdrum daily grind of work and facing the four walls at my rented HDB room. Quite dismal eh?



Then recently, something clicked..I don't know whether my neurotransmitters began firing at full cylinders again, or I actually bounced back from 'adjustment' disorder...I began running and singing/playing guitar without stressing about it. I even regained my confidence in operating and taking charge in the theatre.




Although I am still as confused as ever about relationships, my optimism has returned and I hope one day I will find the 'one'..in the meantime, smile and c'est la vie! looking forward to a return to blogging and more posts & pictures ahead :-)

Happy New Year - a note on my only true vacation of 2010

Life's been crazy lately...with so much of things to settle at work and travelling to do, finally I have a day for myself here in Sg. As it's raining cats and dogs outside, I guess it's time to do some spring cleaning, hatch up some new year's resolutions and blog!

December was also the month I took a genuine break - my only real vacation this entire year packed with unusual events. Hopped on a short flight to Manila for a surgical conference, only to realize that we haven't registered and ended up doing everything else besides attending conference! One thing stood out : our previous fellows a.k.a Manila hosts - they are amazingly helpful, affable and hospitable.

Since my return from Manila and boracay, I've been heaping praises upon the beaches of the Visayas islands. It was an accidental vacation, squeezed in just because we wanted to visit the Philippines General Hospital smack in the middle of Ermita (apparently, a 'scarlet' district during the days of G.I Joes). Thus the highlight of the Manila segment of the trip was to visit the trauma unit in one of the busiest hospitals in Manila.

Conditions were harsh as we saw how the trauma patients were treated. I was simply amazed at how the doctors keep their spirits up. Emerging from the hospital, I was very glad that even the smaller hospitals that I have worked in back in Malaysia wasn't like that.

Stark contrasts abound in this metropolis - the differences between Makati or Bonifacio compared to Ermita, Manila City, etc astounded me at all levels. Its like two different countries. Traffic is of course locked in this ever-present congestion as it takes 1 hour to travel from one end of the city to the other. The least we could do is to visit the most historic part of the city - the Intramuros, Rizal Park, Manila Cathedral and San Augustin Cathedral. The whole area is very different from the rest of the urban crawl. It's actually quite charming and Spanish-looking.

Anyhow, it was of great relief that I landed in Boracay after the hustle and bustle of city life. Now Boracay is and remain to be the crown jewel of vacation islands in Visayas. Being only 50minutes away from Manila or Cebu City by flight, it's very accessible. I bumped into tourists from all over the world - mostly from Taiwan and Korea, though.

Favourite pastimes on the island with the longest stretch of beach imaginable (I couldn't reach the end of the beach on foot) include diving, snorkelling, sailing, fishing, lazing, people-gazing, eating, shopping, eating :-) Or just soaking in the warm shallow clear waters and admiring the brilliant sunset.

This is me during the island-hopping day - exploring the many sea caves on the crystal cove island. I enjoyed the day tremendously as we zipped from one island to another on a tiny catamaran powered by the strong sea-winds. Eco-friendly and very cool :-)

On the small island opposite Boracay island, there were interesting stony structures, reminiscent of those I saw in Ireland years ago.

Thats the 'best' sunset I could get out of the mostly cloudy days here. I guess rainy season ain't so kind to us after all. We had alternating good and bad weather on this island as compared to non-stop blazing sunshine during the dry season in the middle of the year.

We landed on the part of the island near Shangri-La Hotel, almost on the private beach owned by the hotel. It seemed very picturesque, but this part of the island is quite deserted.

One of the many restaurants on the white beach. It was totally packed with all sorts of business - mainly restaurants, massage services, manicure/pedicure/spa, souvenirs stalls, etc. Tourism is indeed alive and kicking on this island.

Will I come again? Yes, I will. With a much bigger group and during better weather of course. Boracay is beautiful!