She's a nurse!

This past August, Asia, if not the world, was seized by the news of the Hong Kong tourists held hostage by a dishonorably discharged policeman in the Philippines. Now, we all know that it ended up as a tragedy, with eight Hong Kong citizens being killed. As I write this, we are still not sure whether they were killed by the gunman or by the rescuers, the Philippines police force having been shown to be disappointingly deficient in resolving a hostage crisis.

Well, all this is in the past, but there was one particular event I would like to mention here. Before the gunman lost control of himself, some hostages—seniors and children—were released.

About 90 minutes into the crisis, a woman called Tsang Yee-lai was told to leave the tour bus with her two children, ages 10 and 4. Tsang told the gunman that another boy on board the bus, 12-year-old Jason, was her relative; she asked to take Jason, too. The gunman agreed and so Jason was freed. Jason, of course, was not her relative.

The people of Hong Kong praised Tsang for her calmness and sharpness in saving a life. Her heroic deed saved Jason, but she lost her husband, and her children lost a father. Jason’s older sister, age 15, was saved, but both of their parents were killed. The incident has been emotionally draining for the people of Hong Kong.

Tsang is a geriatric community nurse working at the Kowloon Hospital in Hong Kong.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Seniors and fast food

As a Hong Kong Chinese, I did not associate seniors with fast food until about 10 years ago, when I moved into an apartment from which, if I needed to get to the train station fast, I had to take a short cut through a McDonald’s.

Every morning I made that trip, the scene never failed to amaze me—lots of seniors having breakfast at McDonald’s. Maybe it is a myth, after all, that Chinese people are particular about food. My—or our, if I can claim that I represent a certain segment of our society—belief used to be that Chinese seniors would not like fast food. They preferred congee to burgers, jasmine tea to coffee. But, obviously, I learnt something new when I moved into that apartment.

When I was taking a course for my doctoral program, my professor told me that she had been to Hong Kong and that both she and her husband were totally surprised to see that McDonald’s was such a favorite spot for children in an Asian city. She predicted that this generation of Hong Kong youngsters would have the same kind of cardiovascular problems as those in her country, the United States.

When I saw the large number of seniors having breakfast at McDonald’s, I remembered what she had said and thought, not only will we have a generation of young people with cardiovascular problems, we will also have a generation of seniors with those problems, as in Western countries.

I remarked about this to a friend, and she suggested it could be the free coffee refill that attracts seniors. This may be one of the reasons, but probably only one. To this day, although not so amazed as before, I am still puzzled. Maybe one day, I will do a survey on this, trying to find out seniors’ perceptions of fast food, and why they patronize these restaurants.

My speculation is that fast-food restaurants treat everybody the same. Our seniors enjoy the same kind of “freedom” as anyone else. They can sit for as long as they like, in spite of buying little, and not be driven away or given strange looks by waiters and waitresses. They don’t have to abide by the rules of a regular restaurant. This, then, is a good aspect of fast-food chain restaurants. They are a place for any age group; there is no age discrimination.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Life and death in education

I am still into experiential learning. My definition of experiential learning is that someone has actually gone through an experience; not a simulated experience, such as just pretending you are blind by putting on a blindfold.

One thing that bugs me is the tendency of the social and health service sectors in Hong Kong to be crazy about getting into the latest trends. First, it was reality orientation (RO) that became really popular. Every agency was trying to conduct RO. Then it was reminiscence, life-story work, music therapy and so on and so forth. The latest is horticultural therapy. Once a craze begins, everybody tries to get a head start.

As a researcher and educator, I am appalled at the lack of planning for all of these activities. Because the trend in question is not well understood and has not been studied, it leaves little room for researchers to examine whether there are therapeutic effects from these interventions. And if there are, what are they? In what ways do they have an impact? These questions often remain unanswered, because there are no baseline data. Also, it is hard to “unteach” myths and misconceptions about what certain therapeutic interventions can or cannot deliver. People have gone too far to embrace the ideas.

But I digress. Another trend of the city’s health and social service sector is life-and-death education. I recall a news item about schools cooperating with non-governmental organizations (NGOs) to organize experiential learning on life and death for elementary school children. They go into a psychedelic (my description) space (room or passage) and play games that ask spiritual questions about life and death. Supposedly, it is thought provoking for the youngster, so that he or she will not shy away from matters of life and death, and accept them as a part of life.

How odd and unnatural for school children to learn about life and death in this manner! How artificial our society has become. Everything has to be structured for our learning. Do we really believe that our children will better grasp matters of life and death after going through this kind of exhibit?

I believe our youngsters would learn a lot more if they had more opportunity to grow up with their grandparents and their grand-aunts and -uncles. Wouldn’t it be nicer to have carnivals to bring generations together? Life-and-death education is something I have learnt about experientially. My friends’ and relatives’ deaths have taught me about life. I believe in learning in a more naturally occurring context. Of course, core family units in today’s highly mobile society are scattered far and wide, with some family members miles apart from others. But the Internet, Facebook, Skype and other technology applications can keep us together. Learning about life and death cannot be left to exhibitions and teachers alone. It has to come from those who really “live” with us, and have a place in our hearts.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

You only know it when you've gone through it

We learn about sandwich generations from books and by talking with friends and patients, but unless you have become one of those being “sandwiched,” you don’t really know what it means. Being sandwiched means not only that you have to look after your older and younger blood relations; it also means constant worrying about your parents and your younger ones, be they nephews, nieces or your own children.

At the moment, my mother is frequently on my mind. She has fallen four times since June. This is worrisome, indeed, but there is nothing much I can do. She lives with my brother in Toronto. My brother has been taking good care of her, but she is getting older and frailer each year.

I didn’t realize there is a comparative advantage of living in a smaller apartment. (Again, like I said earlier, learning has to be experiential.) When my mother visited me in Hong Kong just a few months back, she remarked that it was good that my apartment is small. She could quickly find something nearby to hold onto when she felt dizzy or when her knees gave way.

I didn’t think much about growing old when I was younger. I didn’t worry about saving money for the future when I was decades away from retirement age. In fact, retirement, secured old age, and so on, were not words and phrases found in my vocabulary when I was young.

There is a growing trend for people to say that we need to teach young people about growing old and getting prepared when they are still young; we need to plan for a secure old age decades ahead of time. As a gero nurse, I am not so sure about this. People grow into their own age. Learning has to be experiential. And where is the fun when, say at age 20, you have to be mindful of what you will become at 65?

Would continually thinking about old age take away our drive to move forward, to explore the world, to dream big dreams? Would teaching our young and making them think of old age prematurely rid them of the innocence of a full and “invincible” life ahead? What joy will it bring if we have to calculate risks when we are still young? We need to be responsible for our lives but not to that extent. At least not for me.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

When I was young, I was naive.

I believed it was enough to teach nurses to meet basic requirements in providing care. I believed it was unreasonable for us to ask our students to love everyone. (That is still not a realistic expectation.) I used to believe in standards, quality audits and core competencies. (I still believe in some of these things, but in a different frame of reference.) To my mind, as long as everybody did his or her job properly, that would do.

I was wrong. It is not enough to teach our students to meet standards, have their competencies verified by tests or check, through peer- or self-appraisals, whether they have mastered the required skills.

There are so many different systems of accreditation being developed nowadays. Under modern accreditation systems, piles of documents explain protocols, guidelines and procedures about how things are done in a particular context or setting. They have a limited connection with the quality of care. Having documents in place doesn’t mean that the things said in the documents are or will be observed. It only means that specific instructions exist about how something should be done (and is believed to be done), and when and why it is done in certain ways.

As I grow older and, I hope, slightly wiser, I have come to realize that standards and competencies are not enough on their own. As I lecture, work with students on projects and supervise them in field practice, I am gradually coming to see how flawed my thinking was.

The most important thing about nursing is caring—caring about, not just for. It is only when we care about something that we strive to do well, to do better. When we care enough, we show it in our work and how we carry ourselves in practice. It is only when we care about those we serve and our profession that we strive to become better nurses and people.

But the global trend embraces the science of nursing more than the art of it. Something is amiss, but are we aware of what we are missing?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Do you respect older people?

Do you respect older people? Why? Do you respect older people because of their age? Or for other reasons? If it is because of their age, why so?

Chinese societies are very much into respecting elderly people, with few explanations as to why this should be. I used to wonder why such “wisdom” is passed through generations without being challenged. I have to say that I don’t respect seniors just because of their age. Respect has to be earned.

Just as I don’t disrespect children because of their age, I don’t respect seniors because of their age. Age per se is not a good argument for me. To me, we should respect life, respect people as individuals, having a rightful place on this planet. Seniors don’t get extra respect for the mere reason of being older. There are some young people who put me in awe, and many more who deserve my admiration and respect. And there are a lot of older people whom I don’t respect.
But, of course, there are other qualities that come with age that I appreciate–the ability to withstand adversity, worldly wisdom gained out of a lifetime of experience, and so on. But age is never a good enough argument for me.

As a gero nurse, I advocate for the well-being and health of seniors, not because they are a respectable group because of their advanced age, not because of their growing numbers and looming “grey power.” As a gero nurse, I am cognizant of the right of every member of our society to receive the same respect, irrespective of power, wealth and class. Only when groups live in harmony and recognize each other as having equal rights can we start to build a better world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Development of people-friendly cities: Observations of a gero nurse

Hong Kong is probably not on the list of the top 10 most habitable cities in the world. Although my view is coloured by having been born and brought up here, my bias is not unfounded when I say that it is a reasonably good city to live in—apart probably from the air, sound and light pollution problems we have. (We can do something about the air pollution, but won’t be able to solve the problem entirely because of all the factory smoke that is blown from across the border.)

There are certain prerequisites required to survive in Hong Kong. One, of course, is having strong nerves to tolerate sharing 1,095 square kilometers (423 square miles) with seven million others. This means that one should have the ability to withstand crowdedness, noise, a very fast pace of life and a sense of urgency in everything we do.

Although a “developed” city, Hong Kong is not as “civilized” as cities in Japan. But civility comes with a price—a very high cost of living—because its habitants are paying a lot for the basic infrastructure. As a developed city, we share many ills and strange phenomena with others. Our city may be advanced, but it is not quite a senior-friendly city. With the present trend toward cool structures and minimalism in design, there are just too many glassy reflective surfaces, mirrors and glistening facades of massive buildings and shopping malls around us.

These are not good for aging eyes when glare becomes a problem. The many mirrors and glass structures are traps for seniors who have less-efficient depth perception to differentiate subtle changes in tone between surfaces; without such perception you cannot know whether it is a passage or a mirrored wall. Marble floors, a symbol of luxury, pave most new and recently renovated shopping malls. Even though designers claim that these floors are non-slippery, try walking on them on a rainy day. They are essentially traps for seniors in a modern city.

I have not yet mentioned the problem of finding your way. These modern, massive structures are not simple. You need to learn the language and have a different set of orientation skills than what you learnt a couple of decades ago. First of all, you need to learn how to perform a methodical 3D scan of a large space—I mean 360 degrees front to back, and from the tall ceiling to the ground you are walking on. Often, the signage is hanging high up in the air. (Try to recall a large airport you have visited).

What is more, special signs and utilities are designed to be artistic and blend into the physical space surrounding us. The philosophy of modern design is to make transition of space inconspicuous, blending man’s architecture with natural scenes. Thus, you will need to learn to decode the signs or symbols, making sure you are heading toward your destination.

And finally, you need the energy and ability to cover that long distance to find the bathroom or information counter. It is not always a breeze getting into a building and quickly identifying how to get where you want to go. It is a whole new language that the older generation needs to embrace and understand.

There is still a long way to go before Hong Kong can become a people-friendly city.

Click image area below to view in larger format.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

"Cardboard box" men and women

There is an occupation or informal kind of work in Hong Kong that I haven’t seen in other cities of the developed world. Older men and women who do this work are self-employed. They work both outdoors (on the streets) and indoors (in shopping malls). They have flexible working hours but most work at the beginning and end of a business day. They deal with material and not people.

These are the men and women who pick up cardboard boxes. Hong Kong is a highly commercialized city, so the turnover of material goods is huge. We make, import and dispose of staggering quantities of cardboard boxes. Seniors who want to make a few dollars go around collecting cardboard boxes from shops, if the shopkeepers let them. Then, they take the folded boxes to the recycling dealers and sell them for a meager sum of money.

I think of these seniors as highly industrious, but I have seen with my own eyes some sneaky ones who sprayed the boxes with water, making them heavier when placed on the scales. I have also read about heartless dealers who cheat with their scales so they can pay less.

Of course, there is no such thing as a perfectly honest occupation. Nevertheless, I am impressed by the industrious spirit of these seniors. They don’t want to idly waste their time away; they are doing something useful and making a few dollars at the same time. I am particularly impressed by the old lady who, although both of her lower limbs are amputated above the knee, drives her motorized wheelchair around to visit stalls and collect cardboard boxes. I admire her spirit.


For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Life after cancer

Readers of my blog may wonder what I am up to in my life after cancer. Well, life goes on as usual.

When I first went back to work, I felt fine. I was able to keep my cool and maintain a fairly good balance between work and rest. As time goes by, I find myself increasingly drawn to more and more work, and needing to stay up later and later into the night. This is not a good sign. I am still trying to find a new and healthy balance.

One important impact of cancer on my life is that I have started to exercise regularly. No, not exercising three times a week for half an hour each time, but hiking weekly. Above the village behind the housing estate where I live, there is a path that, after a 45-minute walk up and down the hill, converges with the MacLehose Trail, a country-park hiking trail. Every Saturday or Sunday, I make an effort to hike this path. Sometimes, when I don’t feel like going, I tell myself that it is a medicine that I must take, given the Hong Kong-based evidence that shows a positive association between exercise (or lack of it) and occurrence of breast cancer. Sometimes, when I miss my weekend hike, I try to make it up in the middle of the following week.

Those who hike will know that it is not easy to find a hiking partner. Everyone walks at a different tempo, some fast, some slow and some in-between. So I usually hike by myself. Hiking on my home trail—I call it my home trail now—has opened my eyes to the world of nature. I have seen how a snail flips its body trying to shake a bug from its shell. I have seen wild pigs running down the hill, snakes slither across a path and into the grass again, and sometimes, more alarmingly, wild dogs. I always take a hiking stick with me, not for hiking, but to frighten away menacing dogs. I have become much more aware that I am close to nature, observing different flowers that blossom at different times of the year, or fruit trees that I never noticed before. Hong Kong has 7 million people, and it is hard to find a spot where you don’t run into anyone. But, sometimes, I do not run into anyone up on the hill, and it is as if I have all that nature to myself. Such beauty and tranquility!

Occasionally, when I am alone, I ask myself what cancer means to me. There is also a slight fear that I may have forgotten something important about surviving cancer. Sometimes I feel I don’t know what the important lesson was, while, at other times, I believe the key lesson is that I should remember that a good life is about loving and forgiving. Essentially, life goes on as usual after cancer. And that is already very comforting.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

If you were a senior in Hong Kong

If you were a senior in Hong Kong, I would say you could be pretty sure that your later life would be well covered. Well, of course, you would have to make a noise first of all and get into the system, i.e., register with the Social Services Department, and then take it from there.

Hong Kong has universal health coverage. For a nominal fee—really nominal—you will be seen by doctors in public clinics and hospitals. You will also get the drugs you need, without paying anything further. Some really novel and expensive drugs are not covered, but there are always alternative drugs that the doctor can prescribe free of charge. If you consult a specialist within the public system, then you will only pay HK$10 (US$1.28) per drug item. You only pay HK$100 for a day in a public hospital, which is just US$12.80. If you need surgery (even heart bypass or brain surgery), chemo, anything, it is all covered.

Of course, before getting treatment, you will need to wait in line. There can be a long wait for specialist appointments, ranging from a few months—rarely—to a couple of years. People in Hong Kong need to wait for three years for cataract operations within the public system.

There is also low-cost housing. Although Hong Kong does not have an official poverty line, there is a reasonable social security net. You won’t get overly comfortable if you are on social security, but you will be covered one way or another.

There are home-care services, and all kinds of in-home support to enable you to live at home and out of long-term residential care. If you applied for residential care with the Social Services Department, you and/or your family will have to wait for 3-plus years. There are also day hospitals and daycare services. But there are always long queues to get into these.

The worst is probably dental care. But isn’t it the same in other parts of the world?

Many seniors may have their roots in the Chinese mainland. Therefore, they may go back to their hometown to spend the rest of their lives. The cost of living is considerably cheaper and, also, they are with their relatives. You may lose your social security benefits if you leave Hong Kong for more than six months. However, recently there has been litigation against this policy, claiming that it is against Hong Kong’s “Basic Law.” The results are not yet known.

There are, of course, problems in our elderly services. But, in general, I appreciate all these things that society and the government are doing for seniors in Hong Kong. As a nurse, it is especially hard for me, knowing that just across the border in the Chinese mainland, health care is not a right for all.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Going green and care of older adults

Looking after my mother, age 82, has given me new insights into what it means to be environmentally aware when we look after older adults. It is not so straightforward.

My mother has been very conscious about turning off the lights (and thereby saving electricity) since she was young. But now, when I find her fiddling around in dim light in her room, I am concerned, fearing she might trip on something and hurt herself.

On occasions when I am burning the midnight oil, I notice my mother getting up to go to the bathroom, again finding her way in darkness and not turning on any lights. Though there is a night light in her room, it is dark in the bathroom. It is hard to convince her it would be better to turn on the lights in the bathroom. Fearing she may trip over something, we usually keep a lot of lights on to make a brighter environment for Mom.

That water conservation is an issue in caregiving is something else I didn’t realize before. You are less likely to conserve water if you are caring for a senior. While, in the past, Mom could turn off the tap in a second, now it takes considerably longer. With failing eyesight and less dexterity, it has become more frequent that my mother fails to fully turn off the tap. The tap can run for a long while before someone at home discovers it.

Even when someone is around, trying to reduce water use is not always easy. Mom moves slowly. Everything is always ready for her bath but she takes her time to undress, to check whether she has all her clothes and other items she needs, such as a face cloth. And so the tap keeps running to add hot water to the tub until she finally gets in and washes herself.

Increasing age leads to less efficient adaptation to environmental temperatures. My mother often complains of feeling too warm or too cold. To provide a more stable ambient temperature that makes her feel more comfortable, it becomes necessary to use a lot of air conditioning and heating.

Living with Mom for the last five months has made me realize that, as one who is environmentally conscious, use of sensing technology is very important in looking after seniors. The problem is that people who have lived in their own home for many years cannot always readily switch to using technological devices.

To me, the challenges ahead for gerotechnologists are twofold: developing innovative technologies that are readily adaptable to existing home settings and making these gadgets affordable.

Going green is good, of course. It is something that every responsible citizen should consider and in which they should become involved. However, there are concerns other than higher water and electricity bills. Not long ago, the Hong Kong government passed legislation that vehicles not in motion must have their engines turned off.

Hong Kong, however, lies in the subtropics. In the subtropical sun, the temperature can be significantly higher inside a vehicle. In yesterday’s news, it was reported that an 81-year-old minibus driver had been found unconscious in the driver’s seat. The air conditioning had been turned off while he was waiting in line to pick up passengers. He passed away the next day.
It is not so easy to draw the line between saving our planet and staying safe at the same time.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

About active ageing

My brother and I visited the Fujian Tulou (also called Earthen House) in southern Fujian Province, China, at the end of June. The tulou is an unusual type of Chinese rural dwelling. In 2008, UNESCO (United Nations Educational, Scientific and Cultural Organization) designated the Fujian Tulou as part of the cultural heritage of humankind. I had wanted to visit the place since I saw a commercial featuring a tulou a few years back.

There is an interesting story about the tulou. Reportedly, during the Reagan Administration, the CIA mistook them for nuclear devices and sent an undercover team, in the guise of a cultural tour, to check out the facts.

Tulou are mostly found in the southwestern part of rural Fujian. The area is hilly, full of terraced fields for growing tea and vegetables. Most of the people who live there seem to be engaged in farming or farm-related industries.

Well, this entry is not really about tulou, but about active ageing. One of the images that remains in my mind from my trip is seniors who were busy working in the fields or selling things on the road. They always had something to do. They didn’t seem to be worried or sad. They seemed contented and had a sense of purpose. It made me wonder whether city life has turned us into beings who are far too structured, where there is a time for everything, including retirement from work. There is no retirement in rural living. What better illustration could we have for active ageing than this?


For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience X: Final notes

To find closure, I feel I owe it to myself to document fleeting thoughts and emotions I experienced during my treatment period. I shall declare myself “cured” and will be going back to work on January 18, 2010.

My first thoughts as I write: The hospital is just like a big factory. Like other huge hospitals in Hong Kong, it easily treats thousands of people a day. Staffs are like nuts and bolts in a big machine. To be cured, patients need to be able to fit into the rolling factory lines. Exceptions are unwelcome. You become a nuisance if you dare to be different, even though it’s your body—not you—that may be acting out, developing symptoms and complications that are totally unexpected.

It’s best if your body only responds in ways that are commonly observed. If anything appears other than what the doctors normally see, you are on your own. Factory products are manufactured on assembly lines. Do not expect humanistic or individualized medicine. There is no room—no time or resources—for such practice. Sometimes, no such thing is done, so no one cares to think otherwise, particularly in an OPD. I haven’t been an in-patient. I can only imagine what that must be like.

A few days before my last treatment session, I met a woman coming out of the hospital. She told me she was 85. Her husband, 91 years old, was at home because she had asked him not to accompany her, although he had offered. An energetic lady, she pretty much initiated the conversation. She had completed physiotherapy, but still had pain in her feet, so went back to the reception counter to ask if she could talk to her therapist. The counter people told her that her physio was complete and her patient card had been taken back (by the OPD). So there was no way to help her and she wouldn't be able to find out who her therapist was.

Typical! Of course, something could have been done. Her name or ID-card number could have been used to retrieve her files. But no one was ready to make the effort to help this elderly woman speak with her therapist, find some answers to her problem or negotiate further referrals and treatments.

If you are frustrated or reduced to tears as you are churned through this big factory, you have to get over it on your own. By the third week of my RT treatment, I just couldn’t take it anymore. I hated the chest tightness I felt, which was increasingly bothering me. I asked to see the oncologist. There is one available every Monday, Tuesday and Friday. But when I told this young lady doctor my problem, what I heard was, nothing much could be done. I tried to negotiate a few approaches, but none sounded workable to her. I couldn’t help bursting into tears. I cried because I felt so helpless, that nobody could help me and no one really cared. My tears were flowing for a long while, even after the consultation, even when I got home and got into bed that night, and even now as I write.

Those who are literate need to look after themselves when they fall sick. One cannot rely on the goodness of health professionals to do good for you. This is sad, because there are so many unknowns and so much medical information available, and we are often too ignorant or the experience is too novel for us to ask the right questions. This is sad, because I am a health professional.

I think of how I used to teach care of older people. If I teach undergraduates again, I wonder how I will teach them. I used to think that I taught well. My special ability is to teach people how to think, not just how to do something. But looking back, how bookish my teaching was. Being a patient has taught me new things, both as a patient and as a teacher. I think I will be a better nurse and teacher from now on. Have I told you that already? This is not good news; this is sad news. I have already been a nurse teacher for 13 years.

Breast cancer isn’t a terminal illness. It isn’t even very serious in my case—1.2 cm mucinous (slow growing) tumor, stage 1, with no lymph node involvement. Nonetheless, it is a significant event in my life. Never have I felt such an urge to do good, to be useful, to make some marks during my sojourn on this earth. I think of all the things I have done in my career. I can’t name even one thing that has had lasting impact. All the things I have done seem so trivial. By “something big,” I don’t mean something astounding in the eyes of others.

There is a nurse-in-charge, the assistant superintendent of a nursing home, who always puts me in awe when I think about her work. She doesn’t have a big name in the profession, probably not even in her section of the industry, as her organization is rather modest about the work it does. She is so dedicated to the seniors living in the home; her commitment and care for them put me to shame. There is no way that we can make everyone under our care happy. But how fortunate are the couple of hundred seniors under her care. It doesn’t matter if not all the residents in the home like her and her service; she has led her team to create a caring and thoughtful environment. She has made her mark on the lives of these residents by making the nursing home a more homey place. This is the kind of “mark” I mean.

When I am approaching the end of my life, what will I say about myself?

I am not saddened by such thoughts, only puzzled. I hope these thoughts of mine will keep on urging me to reflect and do good. I hope that going back to work and living a normal life again will not take away the passion I now have to live a meaningful life—not the meaningful life I used to think about, but one that is humble and thankful, and in which I have time to listen and care for those who need it from me.

I will sign off here. Good health to all.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience IX: Voices from my body—anybody listening?

Chronicles of my radiotherapy (RT) treatment:
Day 1: Right breast, particularly proximal to operation site, swollen since evening. Swelling disappeared next morning.
Day 2: Again, local swelling and hardening of tissue.
Day 3: Feeling some muscle/chest wall tightness, like I was unable to stretch my arm or something.
Day 4: Chest wall feels tight whenever I try to move my arm in extension. Really uncomfortable. Shape of right breast changed; grooves over the skin.
Day 5: Same, increasing tightness of chest wall associated with arm movement. I almost need to stretch myself every now and then, or whenever I remember it. Some tingling sensation, like fine needle pricks, under armpit. Darkened nipple and areolar.
Day 6: Reported to therapist and saw the radio-oncologist. Nothing can be done, except to put up with it.
Day 7: Some upper-arm edema. Not sure if it was related to posture while sleeping. Started to feel some very occasional pain under breast, maybe several times today. Pain is only momentary. It goes away quickly.
Day 8: Right breast size has shrunk, also grooves on skin are firmer. Consistency of right breast is hard.
Day 9: Felt sticky beneath the right nipple area. Had sensation of being unable to “free” tissue from sticky tissue beneath nipple, even with stretching exercises. This is annoying.
Day 10: I am documenting this for my own interest. As a nurse, I have studied about RT treatment, but I have never learnt in detail about reactions to RT. I didn’t know what to expect.

Although each person’s reaction to RT or any kind of treatment can vary, I would still have appreciated it if someone had informed me of the possible reactions. Now that I am a patient, I realize that health professionals know very little about how patients feel physically.

I think of how I could learn to be a nurse if I were to learn about nursing again. I would treat my patients as teachers; ask them to tell me how they feel all the time. Only through firsthand experience or good secondhand experience (such as learning from patients), and not through broad-brush approaches like the big category “side effects” that we swallowed in school, can we become better nurses.

I also realize that patients usually only need listening ears instead of “fixes.” I have had doctors and health professionals who halfheartedly listened to my “complaints.” I was only reporting my discomfort and worry (for example, being concerned that my chest would easily become fibrotic). There was no consolation; I was simply asked to put up with it. If only I could find out whether my situation was unique and deserved attention, or commonplace and amounting to nothing. But I couldn’t find out what I needed to know. That is why I say that I would love to learn from my patients, so that I will have answers to address those concerns if I am asked in the future.

I am also aware that, as health professionals, we can’t take every patient’s complaint to heart. Compassion is a highly taxing emotion. It drains our energy. We can’t take all the problems of our patients to heart. We would be so burdened that we could not function. But it is our task to find the balance.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience VIII: Perspective on life

I ask myself what it is I want from life. Or, what do I want for my life now?

Work seems remote nowadays. When Catharine came to visit me in the hospital, she said something like, “Don’t separate your time into what is useful and what is not.”

Yes, Catharine, I do have that tendency. I am conscious of time. Aren’t we all, all of us who were bought up to understand that “an inch of gold can’t buy an inch of time”?

What is it I want from my life? I will not say that cancer is, for me, a life-changing experience, but it does have an impact on how I see myself, and the world. My illness experience helps me realize that I need to do what I like, not what is expected of me by others. I have passed the stage of feeling vain about and for myself. I need to make a mark somewhere.

The other day, on the way to my RT treatment, I stepped out of the minibus and saw an elderly woman. Her hair was all white and she wore a mask. It was during the flu epidemic. Stooping over, she leaned her arm on the bus stop railing to get her balance. She took off her mask and tried to catch her breath, or vomit; I didn’t know for sure. I walked ahead, looked back, returned and asked if she was OK. She bade me to go on, saying there was no need to waste my time, as I must be busy.

She must have mistaken me for one of the staff at the hospital. I went on my way as I was told, not wanting to be late for my appointment, but I regretted it. Why didn’t I stay and help her? She was alone and must have felt unwell, although she didn’t look poorly. Wouldn’t helping this old woman have been much more worthwhile than all the other things I did, like writing a manuscript?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience VII: Bits and pieces, here and there

I remember my first night at the hospital. Thud, thud, thud ... footsteps in the middle of the night, when I was drowsy. I couldn’t see the faces, though. Sometimes, those quick steps came to the foot end of the bed and then turned back. Sometimes, they stopped there for a very brief moment, and then moved away. Sometimes, they didn't come as close. They paused a few steps short of my bed, as if the nurse had come to think about something, and then, when still a couple of steps away from the bed, was satisfied with whatever was on her mind when she started that trip. Then, the sound of footsteps faded away again.

It happened so very often. I kept thinking that they must be coming to check on me, to make sure they had completed all of the required tasks. It was interesting to notice this as a patient. I was not alarmed. For a moment, I considered whether it might have been a ghost or something. I was not afraid. I could perfectly picture the nurses’ actions and motions in my head. They were all too familiar. I had done that lots and lots of times. But I thought to myself, what about older or more superstitious people. Would they ever wonder about these footsteps in the middle of the night? Funny enough, I was never woken by the thud, thud thuds again after surgery. Mostly, I slept through the night, except when it was time to have my blood pressure taken.

I was truly annoyed by the four-hourly blood pressure monitoring. Wasn't it obvious, after the second day, that I was perfectly fine? These actions did not make good sense to me. The Dinamap is also terrible as a BP machine. I never realized it could make people so uncomfortable. It blows the pressure high and then takes a long time for the air and pressure to be released, so your arm is under pressure for a long time. I couldn't imagine how patients feel who need to have their BP taken hourly or half-hourly.

Also, I was not so impressed by the nurses. Other than those who came to visit because they had been asked to by an acquaintance, very few nurses came by to see how I was doing. Well, they did ask how I was doing, but that was just checking on me, and I could feel no caring. The cleaning staff and health care aides were so much better—more caring—than people in the health care business. When they spoke, they were polite, they made small talk and showed that they cared. But not the students or staff nurses. The nurses were merely doing their jobs. I thought the health care aides were excellent healthcare aides, but the nursing staff was so-so. Throughout my four days of being hospitalized, I could have been cared for without nurses, but I am only speaking on behalf of myself as a relatively well and mobile patient. I do not know about other patients on the unit who required a lot of nursing care.

While at the hospital, I noticed that there was too much talk about how the public health system was abused by the general public. This was not my experience. When I was with Amanda in the seating area, waiting to be admitted for surgery, it became clear that lots of ordinary looking people like us—not particularly well dressed, and seemingly not very rich—were using private services, such as this hospital. It showed me that many people would pay out of their own pocket to get better care if they could.

As I went through various facets of the private health care system, I learnt that things sped up because I was paying for private service. It took just over two weeks for me to get diagnosed, get a second opinion, complete further investigation, choose a surgeon, fix a day and book my operation-room time slot. I felt somewhat uncomfortable because I was aware that many people cannot afford the luxury of faster service. I came to doubt my former notion that those who can afford private services still abuse the public sector.

Another thing that made a deep impression on me was Sister Woo's direct instructions about what I should and should not do to take care of myself. Her practical tips helped me a lot. Since I do not usually teach basic nursing, I found myself comforted by these practical tips and the direct approach ordinary people take to care for one another. I tend to offer advice but leave it up to the person whether to take it. Sister Woo helped me understand that, sometimes, it is also helpful to give direct advice. It is at least comforting, even though not always useful.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience VI: Journeying through treatment, amongst other things

My last journal entry is dated October 4, the afternoon before I was admitted into St. Teresa's Hospital. And this is 10 days later.

I have had a lot of thoughts, but no time to consolidate them. Life does not wait for us to get settled. It moves on, regardless of the circumstances.

While I was at the hospital, Sister Woo once asked me how my illness has changed the way I look at life. It was a good question, because, in a lot of ways, I don't think it has had such a profound impact as changing my life. But then her question made me think about things a bit more.

In the hospital, it is relatively easy to stay focused on the metaphysical side of things, to tell yourself that life has many dimensions and that work should be just one of many, to let go of the unimportant matters in life and not be bothered by them, and so on and so forth. Coming back home, back “down to earth,” it is more difficult to stay ”spiritual.” There are repairs needed around the apartment. There is the need to stay connected with families and friends—they will call and you will call them. You also have to sort out what you are going to do next in terms of following up on your own health. Staying in the hospital is boring but singular in purpose. Staying home for recuperation is not necessarily so.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience V: Body as object

My post-surgery recovery has been uneventful. With help from people I know, I was able to see an oncologist on Oct. 14, only nine days after my operation. In the following week, I was able to be seen again—immediately—to tell the doctor of my decision on chemo (which I have decided against), and to have my radiotherapy (RT) planning session. Everything went smoothly, and I am to commence my RT tomorrow.

It has been interesting going through both the private and public health care systems as a “nurse-patient.” I keep thinking, nobody tells you much about your illness (except at the consultation, where you learn more). As a patient, besides what the doctor tells me, I would like to know about all of the relevant procedures. During my first visit to the oncology clinic (my first planning session), nobody told me much. The most explanation I got was during my consultation with the oncologist.

Other than for taking blood pressure, checking my body weight and organizing old films, I have hardly seen a nurse. No nurses, other than my friend Catharine, approached or talked to me, even during my first visit. A nurse was present when the oncologist was with me. What s/he did was to find out the date and time of upcoming health talks, and produce some leaflets about the side effects of drugs and RT for the oncologist to give me. That was pretty much it. Can we blame the public for not knowing us nurses?

I only met receptionists, health care aides, technicians and professionals “coolly,” if not coldly, doing their jobs, oblivious to the possible feelings that a patient may be experiencing. I am aware that I am one of the least worrisome cases, a nurse, knowing people here, coming for prophylactic treatment, having only stage 1 cancer, in relatively good health and coming to this particular hospital by choice. But what about the faces around me? How did those people feel? Were they in pain?

The receptionists were the worst. Because you don't know what they are talking about—go here or there, this window or that, etc., they think that you are stupid or a nuisance. Oh, yes, their expressions show. Because you have to give them a form, or schedule a day to come back, they make you feel that you are bothering them. Even if they don't do it on purpose, the way they do things or how they carry themselves has such an effect. And why are there so many receptionists in an office? I was truly amazed when I first saw that. I do not believe we need that many receptionists or clerical assistants in an office.

All you can do as a patient is wait till your name is called, and then do as you are told. Even the phony politeness at private services is more appealing than the cold, technical, impersonal approach of the public sector. Am I ever glad that I am a nurse, having worked in public hospitals for some years. I know about the places and the people, and I have a general idea of how things will be conducted. I am only sorry that nothing much has changed since I left “public services” in the early 90s.

After registration, my name was called. So I walked to the other end of the hall, only to have my body weight and height checked by a health care aide. Later, my name was called again, this time to go to a room, and I was asked to sit down and have my BP checked, again by an aide. Nurses were around, but just to ask me whether I had brought all the old films with me. The third time my name was called, I finally went to meet with my doctor.

My oncologist was alright. She took the time to explain all the essentials for me. I was, and still am, puzzled at the way things were arranged. It has been more than two decades since we talked about taking away functional nursing in Hong Kong. Still, what I saw was very functional (task-oriented) in our work engineering. I don't think it would involve a lot of extra work and time if the patient were only called once to meet with the nurse—to have his or her vitals done and, at the same time, have a brief consultation to have questions answered and a brief “tour” on likely procedures for patients coming for the first time.

By the way, there were two aides performing the weight and height measuring “service” and at least four when my BP was taken. Such a waste of resources, and no one outside in the waiting bay to talk to patients. So many resources, and yet not very good care.

Then came the planning session. I was taken to a room where a radiographer told me that all three members of their team today were men, and asked if I would mind. I responded that I was OK with that, but a moment later, before the actual shooting of X-rays, a female radiographer came into the room, noticed the composition of the team and said they should have a female chaperone. So they paged a female member of the staff to come and accompany me throughout.

I wasn't quite sure whether the female radiographer had taken pity on me or whether they wanted to be protected against accusations of sexually inappropriate behavior. But that probably didn't matter much. I wasn't aware of the female chaperone until I got up from the bed after all the X-rays were taken. Because she had a fairly heavy build and short hair, I could not decide whether the figure was a man or a woman while I was lying down, and she was standing a short distance from the bed so as not to interrupt the radiographers. So I never knew that a female was with me throughout.

How did I cope with three men stooping over me, making marks on my bare upper body and a narrow cast over my chest? I tried to rationalize and dissociate my being from my body. Just like the staff, who worked with a body and not a woman, I “participated” as an onlooker, viewing what others did to my body. I did not know how long the procedures lasted, at least a good 15 minutes, maybe more. The technicians said that they had four breast cases that day, as if that were a lot. So it must be quite a tedious and time-consuming process.

I was an object alright. Even though the bed I was lying on was 15-20 feet away from the door, I could still see the door that opened into the main waiting hall. People were passing by or sat outside, and staff inside did not pay much attention to whether that door was properly locked. Other staff came in and out, and the door was held open long enough for me to feel uncomfortable. Even though it was only afterward that I learnt that a female staff member had been there, it was still comforting to know she had been with me throughout.

I was then told to go back to the hallway outside the room, to await further instructions about what to do with my marks, subsequent appointments, etc. So I dutifully sat there as I had been told for half an hour or more. I couldn't remember exactly, as I was reading newspapers and talking with my sister Amanda.

The first technician whom I had met for this appointment saw us sitting there, but he said nothing. He was busy. But he later took pity on us and asked us what we were doing there. I said I was waiting to be given my next appointment. He asked whether the planning room technician had not given me the appointment and I said no. He was a bit surprised and said he had already given it to the planning-room people and would now get it for us. So we waited some more. After a short while, he came back to give me the appointment.

I wasn't upset. This is typical of government clinics and even hospital wards. As patients, we spend a lot of our time waiting.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience IV: Doctors are a different breed

I never realized how difficult it is for a patient to get a fuller picture about their condition and its required treatment. I get very frustrated with asking doctors questions. I simply cannot get the answers I want.

Why would doctors think that, because they know more, they can decide for others what has to be done? Ben, my brother, did all the information searches for me, and even prepared checklists and questions to ask, but when I was with the doctor, I could never get through those questions one by one. So I changed my strategy and thought of several broad categories in which I needed more information. I still wasn't very successful in getting answers.

The questions I don’t have answers to are about chemotherapy and hormonal therapy. Neither doctor seems really interested in talking about these aspects. Now that I reflect on it: Is it because they want only to address what is immediate, they don’t think that I am a good candidate for chemo, they don’t want increase their liability by talking too much or they don’t have time? I can’t fathom it. Is it just because they are doctors in Hong Kong? Is it the same everywhere?

I wonder how other people deal with the situation. Just let others make the decision? Put their lives into others’ hands? Now that I have experienced, from the perspective of a patient, the uniqueness of doctors as a different breed, I think of those who may not have a lot of education, may be less adept in problem solving or have limited access to information and communication technology. What about those people?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience III: What a patient needs is compassion

Being on the receiving end of health services, delivered by a long succession of health professionals, parahealth professionals and other unregulated staff, reinforces my belief that, among the many attributes of a nurse, caring is most important. Of course, knowledge, skills and techniques are important, but caring comes first. If we care enough, we will find the right thing to do. For example, Ben did all the searches for me, saving me tremendous time worrying about whether I had searched enough. Screening out all the useless information and pointing out the relevant to me was an enormous help. Thanks ever so much, Ben.

Coming back to compassion. If we care enough, we will be more thoughtful, will adopt the sick person’s perspective and relieve the burden on both the patient and his/her family. I travelled back and forth between the HK SH (another hospital) and my doctor’s offices just because the staff didn’t think of mentioning something to me. So I had to make that extra trip. As time-conscious as I am, I am surprised that I didn’t throw any temper tantrums at having my time wasted on avoidable activities. I think of caregivers who may be old and patients who may be too sick to travel back and forth. I also think of people who are not as mentally stable as I am. Imagine the pain and frustration they have to go through.

I used to think I was a very good nurse. Now I know I can be a better one. Adversities in life can be blessings in disguise. They make me more humane and accepting of other people’s weaknesses. I can now boldly state that “life is precious” and mean it.

Good health to all.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience II: A private experience?

I am an open person. Over time, I have grown out of my shyness and, most of the time, I speak my mind. But I am also a private person. I don't like people nosing into my business, just as I don't nose into other people’s affairs.

But as my illness experience accumulates—going for an appointment, getting a diagnosis—I realize that what is personal isn’t always private. I have to tell the receptionist about my condition and ask questions right in front of everyone in the waiting room. I have to ask my colleague to cover my class for me, as a favor, because I need to go for a doctor appointment. I have to call friends and ask for contacts. I have to call people—experts—I don’t know at all, no matter if they show warmth or coolness toward me. I have to tell event organizers I won’t be able to realize my speaking engagements. I have to apologize for missing meetings I have agreed to. And, I have to tell colleagues and team members about my situation when they are planning ahead for what needs to be done when and by whom. It ends up that, no matter how private I am, I have to tell people about my health problem. I don’t mind telling people; breast cancer is not shameful. But, when I am just trying to deal with it myself, I’m not prepared to share so much about myself with so many others. But illness leaves no room for shyness.

I now learn that illness is never a personal experience, not even a family experience. And I don’t like it when people ask me how I am, even though I have never told them anything. Grapevines spread very quickly. I tell myself I need to accept other people’s good intentions. My colleagues care about me. They want to let me know they care. Therefore, I must graciously accept and not push people away.

In illness, you have to come to terms with the fact that you can no longer entirely be your own boss.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Illness experience I: A new kind of pain sensation

As a health care professional and going through life year by year, I thought I knew pain. But then, after my magnetic resonance imaging, I realized I didn't know pain as I thought I did.

They injected dye into an artery, which is just like drawing blood or putting in an infusion—nothing serious. After they finished my imaging and had taken out the arterial catheter, I had to press the insertion site for five minutes. The site then looked a bit swollen, reddish and was more “painful” than I expected (not really hurting badly, but hurting for sure). It was a strange feeling that I couldn't describe. Because it was a dye and it was my artery, I was wary. Aware of the possibility of adverse events such as allergy or shock, I pressed the bell and called for the technician. He told me he noticed nothing unusual and that my wrist was just like normal. So I had reported it. Just in case anything happened, I had mentioned it. I still felt a bit uncomfortable at the insertion site when I went home. The pain sensation was mild, but it was there. It was a kind of pain I had not experienced before.

Traveling the same bus route, I went back to my office and picked up my mammograms and ultrasound records to take them to the hospital. I thus had plenty of time to take in the new sensation and look at my wrist. After an hour or so, the redness had gone down. So had the mild swelling, as well as the mild pain and discomfort.

If only the technician had known about this kind of pain, if only he had been more observant, he wouldn't have been so adamant about seeing nothing abnormal, because I was 100 percent positive my wrist did look different than normal, at least a little. If only he had known, he would also have known how to comfort and reassure a patient.

I think to myself that, now that I know about a new kind of pain experience, I will be able to reassure my patients in the future. I know now, from personal experience. And I wonder what kinds of pain I will experience from my surgery. I am going to learn about new things. I thought of the moment when the nurse tried to insert an intravenous catheter into my artery. I was really apprehensive. It hurt more when she was about to insert it than when she was actually doing it. Apprehension makes it hurt more. I am handling everything well now, but I wonder how I will do when I go into the operating room.

Well, one thing is for sure. I will be a better health professional after my own experience as a patient. And be assured that I am not afraid. I am not.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Foreword

When the editor of Reflections on Nursing Leadership asked me to write a blog, I was hesitant to say yes but, eventually, I agreed, hoping to foster sharing of thoughts and experiences in health and nursing across continents. The first thing I would like to share is my experience as a cancer patient. I was diagnosed as having stage I mucinous carcinoma on 17 September 2009 and subsequently went through surgery and radiotherapy. During that period, I shared bits and pieces of my thoughts as a nurse-turned-patient with my family and close friends. My illness experience has certainly taught me some important things in my life. Because these thoughts were just for sharing with friends and family, there are no big lessons or dramas. Nevertheless, I would humbly like to share them with you.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.