Gero Nurse

Life cycles of cities

2012-01-06T12:48:00.002-06:00

Hong Kong has had its “glorious” moments. There was a time when China maintained a closed-door policy, and Hong Kong was the only gateway connecting China with the rest of the world. We prospered because of the unique role we played between China and the other countries. Since China opened up its doors under the government of Deng Xiao Ping, Hong Kong’s significance to China has slowly declined.

We used to be a great entrepôt. Not any more. Business routes between major cities in China and the outside world have become direct. Nothing needs to go through Hong Kong before entering China now. It used to be that there could be no direct contact between China and Taiwan. Therefore, people from both Taiwan and the Chinese mainland had to stop over in Hong Kong before moving on to either Taiwan or the mainland. This practice will soon come to a complete halt, as both the Taiwanese and the Chinese governments are eager to boost direct trade and cultural exchange between the two places.

Hong Kong construction worker scales scaffolding.

It is a well-known fact that Hong Kong depends on her mother country to prosper. As other cities in China become more developed and better connected to the global village, Hong Kong is losing its strategic importance. Our previous industrial and business orientations have changed from those of manufacturing to those of a service industry, manifested as banking, finance and tourism. Like other cities in the world, we are going through a cycle: struggle, development, prosperity, fading importance and struggle.

Members of a Hong Kong domestic workers union demonstrate.

Many a time, I hear visitors remarking that other Chinese cities are doing a lot better, implying that Hong Kong is lagging behind in many dimensions, losing its valour and glamour to neighboring areas and major cities in China.

Public housing estate in Hong Kong.

I am somewhat amazed that such remarks are being made. Just as families go through life cycles, so do cities. We have had our share of cheap labor in manufacturing. We were the production house for many developed countries for goods such as garments, toys and watches. Then, because of rising production costs, our factories moved inland to the southern part of China. Even in southern China, the situation is becoming more competitive now. Global manufacturers keep looking for cheaper places to produce their goods. Many production houses have been moved to Vietnam, Cambodia, and so on.

There are few cities on earth like New York, London, Paris or Tokyo, where the city never seems to grow old. Hong Kong may be progressing toward older age. But we are still bursting with life, with a population of more than seven million.

So Hong Kong will lose its attractiveness. But it is my hometown, where I have my roots and where many members of my family still reside. And there is no place like home.

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

Family values

2011-12-22T09:57:00.001-06:00

When I visited Venice and Rome, I saw many older people walking in the streets, shopping or going somewhere leaning on the arm of another adult. I like to believe that those other adults were their family members or close relatives. I’ll call them the older persons’ family, because it makes me feel better. When these seniors paused to sit down at a sidewalk cafe, the younger adult would take great care to help them sit. They were patient and respectful. It was a heartwarming sight.

The situation is very different in Hong Kong. Here, the younger adults are busy working, and it is domestic helpers who take on the responsibilities of caregiving, day in and day out. Nonetheless, families do care about their elderly relatives in Hong Kong. In the housing estate where I live, there are many domestic workers who walk and exercise with seniors on a daily basis. You can see how well they relate to each other by observing how they interact.

Some domestic helpers talk amongst themselves—for example, a group of seniors and an equal number of maids gather separately each morning in the estate’s garden—while others stay close to carefully observe the seniors in their care. There are those who walk fast and drag the seniors with them along the way, and there are also those who allow the seniors to take their time. It is only during weekends and public holidays that you see more local adults taking care of their parents. You will find them in teahouses, parks, shopping malls and so on.

Filial piety has diverse manifestations in different countries.

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

How should we relate to the misfortunes of this world?

2011-12-07T12:09:00.002-06:00

I traveled with my sister after attending the board meeting of interRAI, an international health care research group, in Nuremberg, Germany. I am not a member of this group, but my teacher—my doctoral thesis supervisor—is. Thanks to her, I was invited as a guest. I thought this would be a good chance for me to learn.

After the meeting, I traveled with my sister to Vienna, Venice and Rome. I don’t know why, but the most disturbing thing for me on this trip was the panhandlers and beggars. There are beggars in all three cities. I am aware that I live a fairly comfortable life, sheltered and secure. I am also aware that there are many people who are very unfortunate. But I had no idea I would react this way. This was not the first time I had traveled overseas and definitely not the first time I had seen people who were very poor.

I believe that Hong Kong has no beggars who are from Hong Kong. We have homeless people, but no beggars. We used to have Hong Kong people who begged, but not anymore. I believe that the beggars we see on the streets of Hong Kong come from across the border (mainland China) to make a living. Because the social welfare system of the Government of Hong Kong has developed gradually over the years, no one needs to beg. For me, as a citizen of Hong Kong, this is an immensely comforting fact.

There I was in Europe, traveling as a tourist, enjoying myself, spending money as I chose. But there were people begging for money. I found myself not knowing how to relate, both to them and the situation. I looked at their faces, and sometimes our eyes met. I did not give to those I judged to be “professional” beggars. I gave a euro or two to those I thought might be in dire need. And then I moved on.

There were some old gypsy men and women in Rome who sat in front of churches begging for money. I knew in my heart that day in and day out, they sat there asking passersby for money. Begging has become a way of life for them. I didn’t give them any money, but I was so filled with remorse that I looked at them and apologized. I kept saying, “I am sorry,” “I am sorry.” Even professional beggars are beggars because they have the misfortune to be on a life path that, clearly, no one who had a choice would choose.

Phil Collins recorded a song called “Another day in paradise.” I am very much the person he described: Someone in the street “called out” for help but I pretended not to hear it. Streams of locals and tourists walked past these unfortunate people, just like me.

So what should I do? How do I relate to these people who are less fortunate than I am? Do I go back to my usual life and continue to live as I did, selfishly? Do I give up my limited resources and donate them all to charity? Do I take up charitable causes and live my life as a crusader?

I know I can’t do that. I can’t give all my money away. My sense of security is important to me. What then should I do? How should I live my life? I find my silly self asking the questions I asked when I was a young adult, passionately seeking a purpose in life. Should I not be past that stage by now?

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

So what do we do after retirement?

2011-11-22T13:56:00.000-06:00

I used to tell my sister to keep working and not retire too soon. If we live until 90 or 100 years of age, which doesn’t seem so unbelievable, then retiring at 60 or so means spending a third of our lives not engaged in full-time employment. And that is a long time. Work has many advantages, as we all know. It keeps us in touch with the world, helps maintain social contacts, brings in income and daily gives us a sense of purpose and usefulness. If the job is also interesting and meaningful to us, so much the better.

In Hong Kong, the retirement age is 55 for civil servants and 60 for employees of most companies and agencies. There has been talk of deferring the retirement age to 65 for certain jobs, such as that of academics.

I think that women (or men) who stay home to raise their kids are wonderful. Their children are so blessed. It is an extremely important job but often not recognized. I think that women who try to be working moms are superwomen. It is not easy dealing with competing roles.

If I say that females are the tougher sex, will I be called a sexist?

Inventory on display.

Open and ready for business.

Waiting for another passenger.

May I help you?

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

Form over substance

2011-11-09T17:41:00.001-06:00

Appearance (or should I say packaging?) is overrated, but it is all we are focusing on these days—the presentation, the form, the look. As a teacher, I am sometimes frustrated by the demand or expectation that every lecture I give must be entertaining and that it should use the latest technology, or whatever is in vogue.

I wonder whether people in the audience (be they be the public or students) realize the amount of time that is needed to produce some interactive elements or to build some simulation exercises into a lecture. The use of multimedia in teaching is quickly becoming the norm, but it takes a tremendous amount of time to get the prep work done.

Some would argue that it is only the initial setup that is time consuming, that after that’s done it becomes easier. Not always. Imagine that you have produced a video clip and made a certain point (fact or argument, it doesn’t really matter). Later on, you want to revise your statement based on the latest research findings. What do you do then? Redo the entire video shooting or just make a corrective statement at the end of your clip?

I once watched a TV program about how a researcher in one of the local universities was trying to use virtual simulation, using computers to help children who were autistic. I cannot convince myself that this is a good idea at all. Imagine all the resources and effort required to produce a virtual simulation environment. But a child does not need a game. The child needs a person who loves, cares about and understands him or her and his or her condition, someone who is able to teach things and be patient when the child fails to cope with the demands of the situation and becomes withdrawn. Also, there is no guarantee that the skills one has learnt in a simulation environment can be transferred into real life.

Yes, I am aware that we must move on, that it is only with repeated use of technology that we become proficient. But the essence is not in the novelty of a communication technology. The essence is about the human connection. Nothing can replace it, not Facebook, not Twitter.

Nobody these days seems to be able to sit through lectures and concentrate on the knowledge—the substance—shared by the speaker. Yes, I am aware that, to learn, students need to be interested. Anything that is multimedia is, of course, interesting, more interesting than the words or syllables that make up the sound of words.

But, as a teacher, I do not believe it is my business to put on a show in every class I teach. Is that really necessary? What is the role of students in learning? Is it to learn only if the subject matter or the presenter is interesting? Unfortunately, what is interesting is different for different individuals.

I believe I need to motivate students to learn. I believe that, sometimes, my time is better spent on efforts to make the content of my talk cutting-edge knowledge. When time is short, my choice is always the substance, not the form.

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

Integration: The final developmental challenge of older adults

2011-10-19T17:32:00.000-05:00

According to Erik Erikson, a person’s last developmental task in life is to overcome the psychosocial task of “integration and despair.” Either you integrate your life experiences and rise above them or become desperate for failing to meet the challenge.

I have read Erikson’s writings about the psychosocial task of old age. I have even discussed his perspectives in an assignment for a master’s course I took. But do I really know what integration means?

Does it mean making meaning out of one’s entire life experience? Does integration require us to determine what achievements we have made in our long life? Or to accept the fact that we really are small beings and have led ordinary lives? Does it involve finding out which relationships still bother us and settling all grudges with those we dislike? If that is not possible, does it mean we accept that we will never be able to make peace with those people we can no longer reach, to let it go and not let it bother us again? Or is it about forgiving ourselves for being silly, cruel, vain and stupid at various times in our lives?

What is integration, really? Is it possible? How do you forgive yourself for the tempers you have thrown and the cruel things you have said or done to people? How do you integrate odd and unsettling experiences that, over the years, you purposely have tried to forget? How can things be put into perspective when you cannot make sense out of these weird experiences?

Can integration occur if, after long introspection, you don’t like who you are or have far too many regrets? Can it happen only when you can see yourself in a positive light?

How, in old age, do we integrate all the things that have happened to us over a lifetime? As a gerontologist and a person, I am intrigued. I realize that I don’t really know.

Older people have a lot of work to do in meeting this developmental challenge. And only they can provide firsthand knowledge.

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

“All older people are vulnerable.”

2011-10-05T12:17:00.000-05:00

The above statement is from the lecture notes of an established global nurse leader at a conference on institutional care of older people, which I attended recently. The statement caught me by surprise. No offense intended, but I could not disagree more.

First, it’s patronizing. I don’t think all older people hold similar beliefs about themselves. I think health professionals should be caring and empathic, but certainly not patronizing. We do not always know what is best for others. We would like to think we do, but we don’t, at least not always.

Second, the message seems to imply that people can be categorized purely on the basis of age, according to whether they are fully capable of looking after their own affairs or not. In our society, we generally agree that children and disabled people are vulnerable and require protection, but if we follow the conference speaker’s logic, it would mean that only those in the well adult population are fully capable beings. So where does that leave us? Should we allow only well adults to lead the world?

Vulnerability should be perceived as a multi-dimensional concept when applied to humanity and should be not used as a descriptive label. A disabled person can be physically handicapped and, therefore, vulnerable to environmental barriers they come across in their daily life. A physically frail person can be vulnerable, in that he or she easily falls ill. A terminally ill person may be vulnerable to “assaults” on his or her humanity when the need for analgesics is ignored. A cognitively impaired older person may be vulnerablebecause his or her power of discretion is compromised.

But not all older people are vulnerable. They should not be. An elder with no loss of mental faculties, even though physically frail, can adequately manage his or her own affairs. Whenever we refer to the vulnerability of older adults, qualifying statements are required so that we are not disempowering our older clients.

The first baby boomers reached 65 in 2006. Let us not forget that future cohorts of older people are better educated and economically more secure than their predecessors. They certainly are in a much better position to manage their own affairs, and we should respect that.

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

Engagement in life

2011-09-27T16:02:00.000-05:00

I came across a new term, “the potentialist,” in an inflight magazine aboard Air Canada on my annual visit to Toronto to see my mother. A potentialist is someone who lives life to the fullest. I love the idea. The magazine was describing a couple who, in late adulthood, have found new meaning in life and want to spend every minute of it doing meaningful things, such as tapping into their physical potential, combining vacation with charitable activities, and so on. This is admirable. I have a lot of respect for such an attitude toward life. But wouldn’t it be extremely tiring as well?

There is a Chinese saying about the careful use of time that we all learnt when we were small. I don’t think elementary schools teach these things nowadays, because I have never heard kids talk about it. “An inch of time is like an inch of gold. Yet, an inch of gold cannot buy an inch of time.” What an apt description, if you truly love time.

As children, we were indoctrinated into believing the idea that we shouldn’t waste time. I would feel terribly guilty if I wasted any significant blocks of time. I love to account for things I do. Checking off tasks on a list gives me a sense of control and, more importantly, a sense of accomplishmentand the confidence that I have not wasted my life away.

Yet, I am aware that I am not that self-disciplined. I have wasted and still do waste my time every now and then, largely by doing nothing, doing silly things, or doing things that are unimportant while many more-important tasks lie there awaiting my attention. I can’t help it. I am only human.

I bet nurses are all more or less alike. We multitask a great deal, we hate to waste time and we like to check items off lists. Although, when I think about it, I don’t know if it is because we are nurses, or the fact that most nurses are female, that we exhibit such behavioral characteristics. Quite honestly, I can’t tell.

Coming back to where I started, I would love to be a potentialist sometimes, maybe more often than not. Still, not all the time. Not for me.

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

Are we set in our ways?

2011-09-15T12:13:00.007-05:00

Are we set in our ways when we grow old? Do we become more stubborn in our old age? People ask questions about the possibility of changes in personality in older age.

Stage theorists maintain that personality changes over time, as a person progresses from one stage to another. Trait theorists argue that personality is stable, and cite personality-inventory studies indicating that a person’s traits remain stable during adulthood.

Life-span theorists of human development pose that human beings have considerable potential for becoming what they want to become and accomplish in a lifetime. However, other theorists suggest it is people’s habits that change—habits related to health, vigor, responsibilities and life circumstances—and not their basic personalities. In short, the foregoing can be interpreted to mean that many so-called personality differences are generational.

Is it not reassuring, then, to know that the theory that “as one grows older, one becomes more stubborn” has been debunked? If we are flexible and adaptable when we are young, we will still be flexible and adaptable when we grow old. If we are rigid in our ways at a young age, we will likely remain so as we accumulate years in life.

It is unfair to associate old age with stubbornness. The other message to take home is that, to better prepare for old age, we should nurture open-mindedness and adaptive coping responses.

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

Fast-changing images

2011-09-02T16:40:00.000-05:00

My eldest sister used to live in Wanchai, on the island of Hong Kong. She died of stomach cancer in March 2010. Because she lived there for so many years after getting married—not in the same apartment but in the same district—I knew the area pretty well, too, because I visited her often, ever since I was a child.

I knew the streets, the buildings and the shops. I still go to my sister’s place, because that is where my cousins live. Because I visit the area quite often, I can usually follow the changes that are occurring in the landscape.

I wasn’t quite prepared for what I saw one day, though. Traveling on the tram from Central to Wanchai, I tried to look outside the tram window, through a packed carriage full of passengers, to see if I had reached my stop. I knew I would be close. I was somewhat taken aback by the view of an unfamiliar landscape. The shops and neon lights that met my eyes were unfamiliar to me. Where were the places I once knew?

As in all fast-growing economies, Hong Kong is one of the places in the world that undergoes frequent and rapid changes to her city landscape.

If I become sentimental about lost images in a city, what is it like for our senior citizens? Whenever I teach introductory concepts of age and aging, I ask my students to try to imagine what seniors in their 80s or 90s must have gone through. A senior who is 90 years of age would have gone through the First World War, the Second World War, the war against Japanese occupation (1937-45), the Chinese Civil War (1945-49) and the Cultural Revolution of China (1966-76).

I try to help my students understand why seniors like to save and not waste anything, and why they go a long way to save a few pennies. I hope that, through such reflections, young people will come to appreciate that such “odd” behaviors represent strengths, not weaknesses. However, I have never asked my students to imagine the landscape changes seniors have seen in their lifetimes.

If we consider for a moment what seniors have gone through, it must be a most amazing experience. They have been to places we have not and seen things we have not. We should know, therefore, that all seniors likely have something to teach us, regardless of their background or educational level.

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

Domestic workers, a godsend for Hong Kong women

2011-08-19T11:08:00.003-05:00

If you go the Central (district) or Causeway Bay area of Hong Kong on weekends and public holidays, you will find masses of female (and some male) domestic workers gathering in parks, on designated pedestrian walkways, in the courtyards of huge commercial complexes and along the walkways of overhead pedestrian bridges. It is quite an amazing sight, and it forces you to realize the magnitude of Hong Kong’s foreign domestic workforce.

People grumble about all these spaces being occupied by immigrant workers because they, themselves, can no longer use them. Those who grumble have probably forgotten one very important fact: These domestic workers have freed the women of Hong Kong from the burden of being the main caregiver in their household.

The majority of domestic workers in Hong Kong are Filipinos, with an increasing proportion coming from Indonesia. Those from Indonesia are becoming more popular, as many of them can speak Cantonese, the local dialect, while those from the Philippines speak only English. A small proportion of the workers come from Thailand. While writing this , I learned from Wikipedia that foreign domestic workers make up approximately 3 percent of the local population. There were 284,901 of them in 2010.

We have been hiring domestic workers since the late 1970s. As I recall, they were initially hired to take care of babies and children in a family. In more recent years, many of them are being hired to look after seniors. Historically, women have been the main caregivers in society, and this is still the case. Women are expected to provide care to those in need within a family. For better or worse, domestic workers have set us free. For many, to support a family, both husband and wife need to work. Given the disappearance of large, extended families, the woman of the family often needs help if she is to work outside the home.

After having babies, Hong Kong women go back to work more frequently than women in Western countries. It is rather uncommon for local women to give up careers to stay home and raise their kids. The advantage may be more secure income for the family. The down side is that working parents sometimes over-compensate for lack of time spent with their children by spoiling them. Some of my friends and acquaintances may be highly educated, but they indulge their children just the same. To mitigate the guilty feelings they have for not spending enough time with their kids, they buy expensive toys and gifts, or allow poor choices of foods and games.

There may be many problems associated with having a domestic worker to help us run a home, but I still think that it is great for women in Hong Kong to have this option. A Hong Kong woman can live her life the way she wants. She can raise her kids at home but, if she chooses to have a career, she can hire a domestic worker.

Back to where I started—I think we shouldn’t grumble. We should be appreciative of foreign domester workers’ contribution to Hong Kong.

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

I love TV!

2011-08-12T10:53:00.004-05:00

Television, “human’s best friend”—from the movie “Son of the Mask”—is the symbol of idleness. A person who sits all day in front of the TV is a “couch potato,” lazy, sloppy and lacking in imagination and creativity.

But I do love TV. I love drama, and easily identify with the emotions of people portrayed in a dramatic series. Nowadays, when there is so much “reality TV” around, it is easy to get carried away and feel as if you have participated. There are many interesting stories in these shows: the rich guy who bravely takes to the streets and tries out life as a homeless person for a few days; a man or woman with a regular job in metropolitan London who briefly gives up all creature comforts and lives a tribal life in a remote part of the world. “The Deadliest Catch” helps me appreciate why king crabs are so expensive when they finally arrive on our plates.

I don’t necessarily agree with what these people do. For example, what right do these people from “civilization” have to intrude into the world of these tribes? But listening to the story of a young rich kid who became homeless made me more mindful of how I relate to and interact with homeless people.

TV provides free entertainment and, if you choose wisely, offers great entertainment. How else would I learn so much about the world of reptiles, wildlife rescues and the intelligence of the octopus, if not from “Animal Planet”? How else would we learn what to do in the “Worst Scenario” and what myths to debunk if not for the Discovery Channel?

TV is our connection to the world. I remember reading an article describing how some seniors who were not very mobile and had to stay indoors a lot had a kind of control center set up around them. They would sit in their most comfortable chair in the living room, with the TV in front of them and a remote control by their side. The telephone was also within arm’s reach. The way they were positioned, they could also see whatever was going on outside their living room window. I found this most interesting, and think maybe I will do the same when I am old.

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

Immediate versus delayed gratification

2011-08-04T16:05:00.000-05:00

When I was small, new clothes or new toys were only for special occasions, such as the New Year. So whenever my mom or big sister bought us a new dress, it had to be saved until the New Year before we could wear it. We were so excited and anticipation mounted as the time drew near. We were on Cloud Nine when we finally put on our new clothes.

Not so now.

I watch my nephews. Whenever I buy a new T-shirt for them, if they love it, they wear it immediately. They are very much part of a here-and-now generation.

When I was small, senior members in the family often told us to work hard, and said that hard work would earn us future opportunities. I watch the news. Young people nowadays do not really believe that. While in the past we grabbed hold of any job opportunity that came along if we needed a job, the younger generations in Hong Kong will only work if they can find the job they want. I can understand the sentiment. Unfortunately, the right job does not always come along that easily in life.

When we were kids, our parents told us to spend money wisely and keep our savings in the bank. We were often preparing for harder times, because we never knew what was coming next. Nowadays, the banks are pushing for a larger market share in credit-card business among college students. Some college students have acquired the habit of spending over their credit limit, accumulating large credit-card loans even before they graduate.

Some of my students think it is more important to spend money on the latest iPhone model than to buy textbooks. In fact, they can borrow a textbook from our school for the meager sum of HK $50 (US $6.40) a year, but not many do so.

Today, everyone in the world wants immediate gratification. Everything is about me, I, now.

You may think I am unsympathetic to the younger generation. Not so. This is the world we created for them. If we don’t like the way they are behaving, it is likely we are to blame, at least in part.

As a teacher, I am privileged to be able to mix with some really caring and conscientious young people. I know quite a number of them well, as they work for me as student assistants in my projects. Sometimes, when I look at them, I am happy knowing that, despite what we see and hear in the news, we do have a fine younger generation coming along.

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

Life is bearable because there is hope

2011-07-26T10:18:00.006-05:00

A friend of mine died of leukemia a few months ago. He retired about three years ago and then was suddenly taken ill. Two weeks ago, I went with a colleague to visit his widow. She treated us at a restaurant to dim sum, a customary meal of local Chinese people.

Sundays are family days, and many families go for morning dim sum together. If your friends are visiting, they will be treated, as well. The widow’s son, daughter-in-law and 1-year-old granddaughter were all there. She seemed to be coping well, and we chatted away merrily. Soon, it was time to leave, and she came with us to the minibus stop to see us off. Suddenly, she told us, “I still miss him terribly,” and then burst into tears.

Life must be unbearable for her, because they were married for almost four decades and were very close. My colleague tried to comfort her by asking her to be brave, and to think of her current responsibilities of looking after the rest of her family and her granddaughter. We were in a public place and didn’t really have the chance to talk in depth. She stopped sobbing, and then we parted.

After I got home, I kept thinking of her—her grief and her loss. I wrote her a card. I wish I had had more time and been in a quieter place with her, so that she could cry her heart out. I wish I had had the courage to stop my colleague from talking. The woman needed a chance to express her true feelings.

As a nurse, I am expected to know how to therapeutically communicate with people in need. But, sometimes, I find myself tongue-tied, especially when I am with friends. I do not pretend to know how other people feel, because I don’t. I can’t. I can only imagine. But every individual’s experience is private and special. Nobody else can experience something in the exact same manner. Often, it is good enough simply to be there and listen. Let the person’s grief flow out. It is only in companionship that we feel supported. It is only in telling that we start to heal.

I often tell my students it is unnecessary to fill every moment with sounds when you are with a patient. The ability to tolerate needed silence in a conversation says much about a person’s skills in communication.

Although I am concerned about my friend’s wife, who is now a widow, I think time will be her best friend. The family is close, and she finds immense joy in playing an important part in her granddaughter’s life. In a young life, one can see joy and hope. We can find pure joy in simple matters in a child. Looking at him or her, we see hope for a happier, better future.

Life becomes bearable because there is hope.

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

Honor

2011-07-12T17:09:00.004-05:00

I read this piece of news in the papers. A father sold his home and then worked very hard every day with his wife, making fishing nets to pay off his deceased sons’ debt. Three of his four sons died in a super storm four years ago, owing huge sums of money. The couple is expected to work for years to come, in order to finish paying their sons’ debt. The father said he would do this for his sons. He is honoring his sons by paying their debt. It is not just the love of a father or a strong sense of responsibility that compels the man to do this. I call it honor. He is an honorable man. He is now 82 years old.

I see honorable seniors every day in Hong Kong. They may be old, and some may be a little messy. They are those ordinary people to whom you may not give a second glance when you meet them in the street. Some can be rather peculiar in their behavior, but they are all honorable people to me, just the same. They are respecting life by doing the best they can.

I see many seniors selling all sorts of stuff on the streets. I don’t think they are trying to make money. I doubt they can make good money out of the items they sell—pediclips, hairclips, buttons, rubber bands, candies and so on, which are usually worth no more than a few dollars. What I see is that they are trying to spend their time doing something useful.

An older woman listening to a Walkman and selling goods in a bag; an older man scrubbing the outer shell of an electric fan to remove the rust; a barber cutting hair on a pedestrian walkway under a bridge; a group marking their place every morning outside the train station to collect used free newspapers from passersby for recycling: All these sights tell me about seniors’ ingenuity in finding meaningful occupations for themselves. I find it an admirable virtue.

Senior cleaning rusty fan.

Fan repair king.

Selling phones and other electronic devices.

Seniors collect and recycle newspapers.

Senior retailer interacts with customer.

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

On uselessness and being

2011-06-27T08:59:00.006-05:00

I saw a couple in my Health and Cognitive Assessment Clinic one day. It was the husband who needed to come, upon the urging of his daughter. However, it was clear that the wife needed help, too.

Her physical health was greatly compromised 15 years ago as a result of complications from spinal surgery. She had been through great pain. She told us that, if it hadn’t been for her husband and her children, she would have been dead a long time ago. As we talked more, she became sad. She said she was coping well, because she didn’t talk about something that had happened to her. Whenever she would talk about this experience with someone, she would cry.

She didn’t go out, except for grocery shopping, and pretty much restricted her social activity to her small family circle. She told me how great her children were, supporting her both emotionally and financially. Her husband, in spite of minor memory problems, took good care of her. She pretty much couldn’t do anything for herself now, except take responsibility for her own hygiene. Her husband did the cooking and all the rest of the household chores. She was sad, feeling totally useless.

She didn’t know that her worth was in her being.

I wish all seniors knew that their worth is in their being. Just being there is good enough. Just being there and allowing their loved ones to serve them is a good and useful existence. Imagine the children’s loss and feeling of emptiness and loneliness at not having a mother, or a husband at having lost his wife—it is unbearable. Think of the joy and satisfaction of the children when they are able to take care of their beloved parents.

I sometimes think of one day losing my mother, who is now in her 80s. My father passed away a long time ago; when my mother dies, there will be no vertical lineage that I can claim. I will be all by myself, even though I have siblings. I will be someone without a mother. The mere thought makes me feel disconnected in this world.

Imagine the peace of mind and sense of completeness of a child at having a parent for whom he or she loves to care. Worthiness of existence is not counted by what we can or cannot do, but simply by who we are.

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

Love of a mother

2011-06-14T06:52:00.004-05:00

While I was recuperating from radiotherapy, my mother came to stay with me for a few months. Because she has memory problems, she could not remember that I was suffering from cancer. My brother and sister told her, but it didn’t register. Every now and then, my brother and sister and I would talk about my illness, such as taking my traditional Chinese medicine or going for follow-ups, etc. On these occasions, my mother would be reminded of my illness and then remember that she must thank the gods for me. Most Chinese people in Hong Kong have no particular religion, except worshipping their ancestors. My mother is this way.

One day, she asked us to buy a cooked chicken, fruits and Chinese rice wine, in order for her to thank the gods for having mercy on me. I bought a whole chicken, as is the traditional Chinese custom when you want to worship or show your gratitude to the gods.

It was a bright and sunny afternoon. We got the table ready, with the dim sum, fruits, teas and wines all properly arranged, just as Chinese people do when they make offerings to the gods. We even got some incense sticks burning.

My mother kowtowed to the gods for me. While on her knees, she softly mumbled her prayers, asking our ancestors to continue to bestow mercy on me. It had been a long while since I had seen my mother kneeling down praying to the gods. Nowadays, we are her “representatives” to go sweep the graves during the Ching Ming Festival. She is somewhat wobbly on her feet.

We were to go to my older brother’s home for dinner that evening. After appeasing the gods, the next thing to do was to cut the chicken. We wanted to share it with him. Western people use a knife or kitchen scissors to cut, but we use a chopper. As a child, I saw my mother chop up a whole chicken on a chopping board many times. I am aware that my mother is growing older and frailer, but I didn’t realize how weakened she has become.

I have vivid memories of my mother chopping up an entire chicken and then putting the pieces back together again in the shape of a whole chicken. She now struggled with the chopper and did not have the strength to cut the chicken into halves. After a couple of unsuccessful attempts, I took out my scissors, and then Mom used it to cut the chicken into pieces. I offered to help, but she said that I wouldn’t know how to do it. She forgot that I am a grown woman. My heart ached to see that my mother could no longer do things that she was good at. I was not cognizant of the full picture of what my mother has lost to aging. The gulf between the images from back when I was small and the image I saw at that moment made me mourn my mother’s loss.

All these years that my mother has slowly been growing old, we have gradually been doing more and more things for her. My mother no longer takes care of us. We take care of her. She is used to not doing anything in particular and keeps calling herself “lazy.” But she actively took charge when she wanted to please the gods for her daughter.

This will probably be the last thing that my mother will do for me.

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

On laws that you must make provision for your parents

2011-06-02T10:48:00.006-05:00

I find it interesting as well as intriguing that Singapore and some provinces in China have laws stating that one must make provision for one’s parents. In those places, filial piety is not just part of a citizen’s moral obligation, but a requirement of the law.

What if the parents are awful parents? What if the children make provisions for their parents, but verbally abuse and mentally torture them? What if the children do not love their parents, and only provide for them out of a sense of duty? Would the parents like that? Would proud parents accept money from their children in that situation? What if the parents are well off but the children are not? I gave birth to my children and raised them until they could stand on their own two feet. Does that qualify me to receive lifelong provision from them?

I am very interested to know how the law addresses these questions in view of the complexities of human relationships.

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

Reverse mortgaging finally coming to Hong Kong

2011-05-25T14:39:00.007-05:00

When I was studying in Toronto and learned about reverse mortgaging, I thought it was a great idea. I still do, but it took a long time for it to happen in Hong Kong. In 2010, the banks finally started looking into its potential. I don’t know if it will work, given that Chinese people are so attached to the few bricks over their head. A sense of security for a lot of older people comes from the knowledge that they have a roof over them. Will they be able to give up this certainty and trust the bank enough to do it?

There is an interesting story to share about reverse mortgaging. Jeanne Calment, a French woman who lived to age 122 (1875-1997), had the longest confirmed human life span in history. When she was 90, she sold her apartment to a lawyer, Andre-Francois Raffray, on a contingency contract. It was agreed that he would pay her 2,500 francs a month until she died, and then he would own the apartment. She outlived Raffray after receiving more than $180,000, more than double the market price.

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

The true value of things

2011-05-19T11:08:00.015-05:00

I started using handkerchiefs a long time ago. I don’t exactly remember why, as it was so long ago, maybe because it seemed to be fancier, more romantic back then. I use them now to be more eco-friendly.

I was as vain as anybody else as a young person. I bought expensive handkerchiefs, such as the one shown in Exhibit A. And then, because I used them a lot, my mother one day bought me some hankies, such as the one in Exhibit B, from the market, where she went daily. I absolutely abhorred them—terrible design, poor quality, cheap-looking things—but, somehow, I never got rid of them.

There were some periods in my life when I used paper towels or tissues for convenience. When I finally reverted back to using hankies, I took out the handkerchiefs that my mother had bought me—and I use them. Not for a moment do I feel embarrassed about these unappealing handkerchiefs. They are not soft to touch, even after repeated washing, but they are functional, nonetheless. They were given to a daughter out of a mother’s love.

As I use them now, I think of the daily trips my mother made to the wet market close to home, to see what was fresh and enticing, to plan meals and buy food for her family. I picture that, one day, she came across some hawkers in the market selling handkerchiefs, and she thought of her daughter and believed that she should buy some for her. She looked through the stock and chose a couple that she thought were pretty. She must have been pleased that she had found something useful to give to her daughter.

She must have been somewhat disappointed that her little present was received with a somewhat indifferent, at best lukewarm, response. But my mother would not remember that now. It was one of a million things that, like all mothers, she did for her children.

Age offers people many advantages, one of which is giving us sufficient distance to adopt a broader perspective when appraising the true value of things in life.

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

Making our mark

2011-05-10T11:06:00.003-05:00

Ambitious people are not the only ones who like to make their mark on earth. Ordinary people who accept who they are also like to leave their mark.

I hike every weekend, as I have told you before. Over time, I have met people on the trail who are regular hikers, like me, and I have made their acquaintance. Some of them have grown attached to the trail and decided they have the right to do things to nature and the trail.

A trail doesn’t lie static. You will see occasional changes here and there that slowly modify the “scenery” of the path you thought you knew so well. I have started to observe things that people do to the trail. I have seen people—actually, I’ve seen the results rather than people at work—opening up small terraces by the hillside, in order to make more room for their daily exercise routines. They treat it almost like their own garden, and try to beautify the space by planting flowering shrubs along the border of the terrace they have created.

In another spot, some hikers must have burnt the grass to enlarge a small sitting area. They have cut off the smaller branches of surrounding trees to allow more sunlight to shine into the area.

Once, I met an elderly man who proudly told his companion about his gardening achievements, how he had relocated a small tree from another spot and planted it here. It hadn’t worked out, and now he had put a new tree, also transplanted, in that location, and he hoped this one would work out fine. I find it fascinating to hear his references to the hillside, as if it were his own garden.

I guess we all want to make a difference in this world, in whatever manner it may be and regardless of our humble origins. But, to my mind, children are the best mark we can make on this world.

We are so accustomed to thinking of age in relation to categories—children, adolescents, adults, seniors—or in terms of needs and functions—start pre-school at age 3 (or whatever), start to drive at 18 (16 in some countries), join a senior center at age 60, and so on. If we try to think of age in a nonlinear and expansive manner, not limiting our ideas of age and ageing to the boundaries of a physical body, and if age is a mark that we make as we travel through time, which changes in form and nature depending on our growth and development, then this mark gains or loses significance one way or another over time and finally becomes a mark we leave behind on this earth. Looking at life this way, it is not just great people who leave their marks on this earth. We have all left our “footprints” somewhere as we age. Isn’t this idea immensely comforting?

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

Hong Kong, a highly age-integrated society

2011-04-20T18:04:00.010-05:00

I never realized how highly age-integrated Hong Kong is until I visited Singapore. Singapore, a garden city, is very pretty and highly organized. If you walk around downtown and along Raffles Place, you will not run into older people, no matter what time of the day it is. It is entirely a young peoples' world. Even as I visited beach areas famous for seafood, I found hardly any families bringing seniors along to dinner. The only exception is probably Singapore's Chinatown, where I may have met more people who were older.

This is in stark contrast to Hong Kong. Here, you run into seniors anywhere who are going about their business. In the Central District—the business core of Hong Kong—you brush shoulders with young and old alike. You find rich seniors having high tea in the Mandarin Hotel—you know they're rich by the way they dress and how they carry themselves—and you run into seniors picking up cardboard boxes to sell to recycling merchants. Hong Kong seniors may shop at the famous Lane Crawford emporium, or they may be selling small items (scarves, imitation jewelry, scissors, fans, all sorts) in their stalls on a side or back street in Central. Both the young and the old fight with you for use of the pavement, and we all jaywalk.

I once asked a Singaporean friend why I so rarely find seniors in downtown Singapore. She told me it was because they did not need to go downtown. All their needs could be met in the housing estate in which they lived. Housing communities are designed to be self-sufficient in Singapore, with clinics, shopping malls and community centers. But I still do not get it. Because their needs can be met entirely within their neighborhood, they have no business visiting downtown at all?

I have tried hard to think of the reasons that may account for the differences between the two cities. I can't put my finger on it. I think back to other cities I have visited—Stockholm, London, Taipei, Chicago. Now that I am trying to make sense out of an observation, I am no longer sure of what the other cities are like. But I am certain that they are unlike Singapore, which has made a deep impression on me in this regard.

I strongly object to retirement communities. I would not move into one myself. Why do we need age-segregated communities when, in the real world, people of all ages live together?

Yes, young people can be cruel sometimes, mocking those who have grown old and frail. But not all young people are so. Yes, the amenities of a retirement community may be quite attractive, but meeting with people from all walks of life is much more interesting. We can only promote understanding and acceptance between generations if we live together, not separate from one another.

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

Burial places

2011-04-14T12:41:00.004-05:00

Hong Kong is very crowded by any standard—426 square miles of hilly land masses hosting a population of close to 7 million. We fight for a space of our own when we are alive, and our loved ones may still need to fight for a space for us when we are dead. I say “fight,” because I mean it.

Chinese people love to buy their own living space, instead of renting. Because space is at a premium here, housing occupies a huge percentage of people’s monthly income. Given the motivation to own their own apartment (not houses; few people in Hong Kong’s urban area can afford to own a house), people have to fight hard in life to make ends meet.

Recently, the way people “fight” in Hong Kong to get a spot for themselves or deceased family members hit the news headlines. Although burial is a Chinese tradition, nowadays it is no longer the norm. Burial land is scarce and, therefore, very costly and only for the privileged. More and more people now opt for cremation. But Chinese people believe it is not good to keep your ancestors’ ashes in your home. The forces of yin and yang will not be balanced; yin will be too strong. Urns should be kept in proper places, either in a cemetery or a columbarium (a place for the storage of cinerary urns). Public columbaria are not affiliated with any religion, but private ones are usually built and maintained in accordance with Buddhist traditions.

Because of the severe shortage of spots for urns, business-minded people have developed illegal columbaria. The problem surfaced when the government tried to put these illegal operations out of business. Unfortunately, there is no simple answer to the problem, even though the government intends to build more public columbaria. Nobody wants one in their neighborhood.

When I die, I would like to donate all my tissues and organs, if they are still usable, and then have my body cremated and my ashes used to plant a tree. I don’t need a tombstone or an urn. As society becomes more liberal, discussion of life and death matters becomes less of a taboo. Many elderly Chinese people do make plans for their funerals and burials. This is a good thing, as the family will be comforted to know that they have done what their loved ones wanted.

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

Social security in Hong Kong

2011-04-06T14:00:00.006-05:00

In Hong Kong, when a senior wishes to apply for social security—locally, we call it Comprehensive Social Security Assistance (CSSA)—they have to sign a statement declaring that their offspring will not support them. What an infringement of a person’s rights!

Some people do not like to sign such a statement. Other times, sons or daughters will not allow their parents to make such a declaration, because doing so would not reflect well on them. In these cases, the poor, older person has to rely on the non-means-tested Old Age Allowance (OAA), a sum of $1,000 HK provided by the government to all seniors at age 70.

CSSA carries with it a social stigma. Many who do not want to apply for CSSA will try to live on the meager thousand dollars provided by OAA, which means an unimaginably hard life in a city like Hong Kong, where the cost of living is not cheap.

While surveys and research reports in the Western world show that most older adults have finished high school, studies here report that the mean number of years of education received by Hong Kong seniors is only two to three. Many of them do hard manual labor their entire lives. Hong Kong is an affluent society but, as in many advanced countries, most of the city’s wealth is possessed by a very small percentage of the population. Our older folks, in particular, are not well off.

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

Reverse ageism

2011-03-29T18:23:00.014-05:00

Some of our students participated in a volunteer project, visiting seniors we believed to be “hidden” from society. They either lived alone or without adequate social support.

I went with one of the students to visit an elderly woman in her 80s. She was a nice, pleasantly plump woman who manages very well on her own. She can walk around independently, albeit slowly, and she can go shopping and attend medical follow-ups without assistance. She says she likes staying home, and hardly ever goes out. We tried to encourage her to join the nearby social center, which is why my student was sent to visit her. But she was clearly in possession of all her faculties, and knew what she wanted. She said she didn’t feel bored spending her time at home. She had worked as a maid/nanny her entire life. Although she lived alone, the children of her former employer, whom she had served for many years, would call and visit her every now and then. She had brought them up and was like family to them. It was clear that she was not depressed and was very much in control of her own affairs.

After speaking with her for a while, I came to realize that she was not in need of any external help. She did not like to join trips organized by the center because she didn’t want to make others wait for her. She did not want to spend more of her time at the center because she was the kind of person who didn’t like to be in lots of group activities. She was not what we would call a role model of active ageing, but she was self-sufficient. She was leading the kind of life she wanted and was not making any intentional efforts to isolate herself from others. She was not “hidden” from social services. She had limited social contacts, but this was, indeed, the way of life she intended to lead. Who are we to say that she needed more social contact?

With the hype about healthy living and active ageing in recent years, we have formulated notions about living and ageing, what active ageing means and how to go about ageing in an active manner. We have a stereotype for those we think have aged successfully.

During our 45-minute visit with this woman, I reminded myself once more that I must not let reverse ageism cloud my lens, that I should respect people’s choices of how they live their lives and that I must not impose what I believe is right on people who have experienced living a lot longer than I have.

I do believe there are multiple models of successful ageing. Active ageing is but one of them.

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

The luckiest generation

2011-03-21T16:44:00.006-05:00

The first batch of baby boomers has been turning 60 since 2005, 60 years after the end of the Second World War. To my mind, the baby boomers—myself included—are the luckiest generation ever.

We were able to appreciate the world when it progressed at a much slower rate, and we are also able to adapt to the fast-moving world of today.

We are able to appreciate nature when we travel. We look out of trains at the scenery rather than focusing on our latest portable IT gadget, whatever it may be.

We appreciate the relaxed feeling that comes after exerting our physical body in vigorous exercise. We also like Wii, but do not use it to replace real exercise.

We enjoy life, and we also appreciate the virtue of hard work. While maintaining a good quality of life is essential to us, we also know the value of saving money in the bank. Statistics tell us that wealth accumulation is higher among baby boomers. We are also aware that the younger generations are more inclined to enjoy life, rather than being work-driven like their parents and grandparents.

We know about the joy of writing and receiving letters, but we also appreciate the instantaneous advantage of e-mail and are quite ready to use it or learn how to use it. We are definitely better at spelling.

Call it the bias of the older generations, but I do think we are better equipped to appreciate the arts and craftsmanship of older times. This is because we were brought up in a period when the world moved at a slower pace.

We have the best of both worlds—an older one and the current one—and I am grateful for that.

Having made these observations, I remind myself that, to better understand the younger generations, I must keep an open mind. As a researcher, I should know that humans are easily blinded by prior experiences and perceptions. I remind myself that I must not become so set in my ways that I am unable to see the virtues of generations other than mine.

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

Fair and chic

2011-03-14T11:11:00.020-05:00

A nice tan is much pursued by ladies (and maybe gents) of the West, but it is not so for people in the East. While the tan of someone in a Western country may be the result of a vacation in some exotic tropical place, dark skin is undesirable in the East.

Have you ever noticed while traveling in Asia that women (and men too, sometimes) like to carry an umbrella with them to shade them from the sun? It is not only older women who do this, although they are more inclined to do so. Many younger Asian women are aware of the damage that ultraviolet rays will do to their skin. Lying on the beach or the balcony to enjoy the sun is not a common pastime for Asian women, unless they are very westernized. Fairness in complexion or, to be exact, whiteness of the skin, is valued a lot more than a nice tan in Asia, probably by both sexes.

If you travel in Vietnam, where a bike—motorized or non-motorized—is a common vehicle for commuting, you will see women wearing long detachable sleeves on their arms. The same if you visit Japan; you will come across many women wearing large-brimmed hats and detachable sleeves on their arms while taking a stroll in the park.

While a tan on someone in the West may indicate affluence, in the sense that they have taken a vacation to enjoy distant beaches and the sun, it may imply something different in the East. Traditionally, only Asian women who are from the working class need to work outside of their home and be exposed to the merciless sun.

There is a saying in southern China that mere whiteness of the skin is capable of masking three counts of ugliness in a person. So there you go.

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

Reflections on student learning

2011-02-18T12:01:00.005-06:00

This semester I am teaching a course, “Nursing older people.” One of the assignments I have for my students is to write a reflective journal about any issue pertaining to elderly people and elder care, to be submitted at the end of the semester.

I thought it was an easy enough assignment but, to my surprise, my students do not think so. They tell me it is a burden to them. Quite a number of them say that they don’t know what to write about or how to write it. Again, this is a surprise, because these are third-year students, and reflective journals should not be new to them.

In response, I have modified the assignment with regard to it being a requirement, but have not removed it as part of the course assessment. To me, it is important when studying gerontology to cultivate sensitivity toward elder care issues. The best way to do that is not to write a paper or take a test, but to reflect, over time, on issues pertaining to elder care. Gradual sensitization to elder care issues through the writing of journals will help students develop awareness and insight about care of older people and, I hope, enable them to develop their own perspectives about the study of aging.

But this is not an age that encourages reflection. We humans like to fill our world with sounds. We are so uncomfortable with quiet moments that we try all means to drown our senses.
We need to be entertained every single moment. As soon as we arrive home or check into a hotel room, we turn on the radio or TV. We are defined by the latest electronic gadgets and games, by the PSP, iPhone, iPad and so on. We must have music constantly, whether it comes from an iPod or any other means. We can’t be bored.

We also can’t bear not being connected, even for brief moments. We have the Blackberry, 3G phones, WiFi, etc. Everywhere we go, we want immediate access to the Internet.

Because we are so busy entertaining ourselves, engaging in dialogue with people we know or don’t know, being reached and reaching out to othersand accessing information for all realms of our lives, the time that remains for reflection and recollection is very limited. Although Schön’s seminal article on reflective practice was published in 1987, more than two decades ago, fostering reflective practice nowadays runs counter to modern techno currents—not a very promising battle.

Personally, I need a lot of time to myself. I like people, but I also like solitude. Getting together is good to foster relationships, but getting close to myself and knowing how I feel and think is crucial to living a life that is meaningful to me.

I hope my students become, through repeated learning opportunities, better reflective practitioners.

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

Signs and symptoms of having had cancer

2011-02-04T11:32:00.004-06:00

I thought having cancer hadn’t changed me much. But, as time goes by, I notice that, indeed, I have changed, although in less conspicuous ways.

Symptom 1: Becoming sentimental
I have become more sentimental. I notice that I am very much into taking pictures nowadays, much more so than before. I carry my camera around a lot. As time goes by, I realize that it is because I try to capture glimpses of my life, knowing that every small chunk of time is but a fleeting moment. These fleeting moments will, one day, add up together to make my whole life.

Symptom 2: Becoming more sociable
I have become more geared toward having parties and social gatherings. In the past, my project teams would just meet to discuss things. I rarely called for parties and get-togethers. But now I do. I used to enjoy time with myself—doing household chores, listening to music, reading books and magazines, watching television. Now I make more effort to be with others, and I make mental notes to remind myself how nice it is to be around people.

Symptom 3: Becoming more forgiving
Things students do that irritated me in the past are no longer as offensive. For example, I can’t tolerate it when students keep chatting while someone else is speaking, be it a guest speaker, other students or me. I consider this to be very rude. These days, however, when students still happily chat away in class, I am not as mad. I still ask them to please take turns to speak—between the speaker and audience, that is—but I don’t get upset like I used to.

I would say that these changes are for the better. And they are changes I did not quite expect. They must be linked to a reframing of my perspective on life after having cancer.

I hope they stay.

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

Modes of suicide in the East and West

2011-01-18T12:20:00.005-06:00

My students were miserable and complained about having no ideas to write about for their reflective journals. To help them reflect on elderly care issues, I taught them to use newspapers to identify possible topics.

I started searching for news clips in the papers. Within a day, there were six different news items about older people. One was about a couple leaving a baby in a pram in a mall. After failing to locate the parents for more than an hour, the security staff reported the incident to the police. Eventually, the couple—husband, age 67, and wife, 28—got their baby back from the police station. Next, a senior was knocked unconscious by a vehicle. Third, a fire in a nursing home warranted emergency evacuation of its residents. Then, there was a senior who got drunk and injured himself. Last, two elderly people with chronic illness—a man and a woman—jumped to their deaths.

Common means that elderly people resort to when ending their lives in Hong Kong include jumping from a height, hanging and burning charcoal in a closed room, resulting in death from carbon monoxide poisoning. These methods of suicide are somewhat culture-specific. With space at a premium and the majority of our population living in high-rise apartments—and I mean more than 20 floors and sometimes as many as 60 or 70—choosing to jump as a suicide method is probably out of convenience and ease of availability. Of course, in the West, hanging is also a way to commit suicide, but it is more common among the Chinese. Burning charcoal is becoming more common but, in the past, hanging has been a popular choice.

I wasn’t aware of the cultural difference until I was studying at the University of Toronto and a classmate asked me about it. She was curious and concerned as to why older Chinese people she had come across at work had resorted to ending their lives by such a drastic act as hanging. She was a social worker, you see. At that moment, I became aware that something I had thought was ordinary was, in fact, not so in another culture.

To us Chinese, or at least Hong Kong Chinese, there is nothing drastic about death by hanging. We have learnt about this method of committing suicide since we were small. We watched it in movies and traditional Chinese operas. Whenever a hero or heroine (usually a heroine) in a tragedy wanted to commit suicide, he or she would throw a string or a piece of long cloth through the main wooden frame that held the house together, tie a knot, climb onto a chair and finish the business.

Mostly, these were scenes created for the drama. Sometimes, they were about a heroine fighting against a family that forced her to marry into riches and fame and forget about the guy she loved. Also in these films, if the emperor wanted one of his concubines to die, he would order his officers to throw a long piece of silk cloth at her. Traditional Chinese movies are not graphic at all. So now you can see why killing oneself by hanging is not seen as something drastic in the Chinese population.

I found this revelation quite interesting (not that suicide attempts are interesting, but that observing the differences is). People in different cultures differ not only in how they live their lives, but also in the ways they choose to die.

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

About mental space

2011-01-04T15:02:00.004-06:00

As an academic, I write a lot. I write research papers, discussion papers, speeches, funding proposals, program documents, consultation reports and so on and so forth. So I am not new to being a “writer.” After starting this blog, however, I have been introduced to one of the worlds of a writer that I had not thought about.

I have not been up close and personal with people I do not know. Such particulars about myself, I typically only share with friends and close acquaintances. I know to whom I have spoken and why I would have told them about myself. But I feel strange knowing that someone about whom I know nothing can come to know my intimate thoughts and feelings. I need time to get over this.

I already know about cultural differences from back in my student days, when I was in England learning to become a midwife (studies I never put into practice, as you are probably aware, if you’ve been following my blog). It was my first trip away from home and, therefore, the biggest culture shock I ever experienced. I was somewhat taken aback that people would share their life stories with strangers they met on the street, or in places such as train and bus stations. I didn’t think—and still don’t think—that a regular Joe or Jane in the Chinese population would do something like this. It is not about whether readiness to share details of one’s life with strangers is good or bad. It is just that there are cultural differences with regard to how we relate to other people.

I thought the British were more reserved, but my first-hand experience as a student midwife in England told me otherwise. Chinese people are more “reserved” with strangers. And it is not just about keeping “face.” As I become more exposed to the world outside my hometown, I am coming to realize that there is, indeed, such a thing as “national characteristics.” Sometimes, it may be an over-generalization but, at other times, you will notice similarities and differences between cultures. Well, with modernization and globalization, we are behaving a lot more like each other, no matter whether we live in the East or the West.

Back to my musings about writing a blog. So this is what a blogger will have to come to accept, that there will be people who know his or her personal particulars and innermost thoughts, even though the writer doesn’t know those people at all. To me, it takes a person who is very comfortable with him or herself to be a blogger. Then again, maybe not. I am new to the experience.

I start analyzing why I don’t feel secure having people I don’t know knowing about me. I ask myself why I don’t readily give the URL for my blog to students and acquaintances. I think it is because I have been a rather private person all along, and I am one of those who need a lot of space between other people and myself, including those I love or am fond of.

Yet again, this is a lesson for me to learn. Why not take it easy? Why not accept it as it is? We are, after all, living in the age of the Internet. As I reflect on this, I realize there is a fundamental difference between me and those who have no reservations whatsoever about making friends over the Internet, who incorporate the cyber world as an integral part of their regular world.

Maybe I can further contemplate this idea and use it to help me better appreciate the differences between Generations X, Y and Z. After all, there is no better way to learn something than firsthand.

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

She's a nurse!

2010-12-21T10:35:00.001-06:00

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

2010-12-07T11:43:00.004-06:00

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

2010-12-02T10:30:00.014-06:00

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

2010-11-23T14:47:00.004-06:00

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.

2010-11-17T08:47:00.006-06:00

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?

2010-11-08T14:44:00.002-06:00

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

2010-11-01T14:56:00.007-05:00

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

2010-10-25T12:53:00.005-05:00

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

2010-10-15T12:22:00.021-05:00

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

2010-10-08T10:01:00.008-05:00

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

2010-09-24T09:51:00.004-05:00

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

2010-09-14T14:30:00.038-05:00

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

2010-08-26T10:45:00.003-05:00

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?

2010-08-17T10:00:00.006-05:00

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

2010-08-11T14:26:00.005-05:00

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

2010-08-04T15:25:00.003-05:00

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

2010-07-29T09:03:00.003-05:00

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

2010-07-21T16:03:00.004-05:00

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

2010-07-07T09:22:00.003-05:00

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

2010-06-23T10:37:00.003-05:00

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?

2010-06-15T09:25:00.005-05:00

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

2010-05-28T10:00:00.007-05:00

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

2010-05-27T15:39:00.001-05:00

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.