Saturday, April 3, 2010

An everyday hero

The Straits Times Jun 16, 2009

Injured in the spine due to a surgical accident, Jack faces life with no bitterness or self-pity

By Lee Wei Ling

My patient and friend Jack is 59 years old. For the last five years, he has suffered daily the consequences of a spinal cord injury caused by a surgical accident.

He was operated on initially because he had difficulty walking. The bony spinal canal surrounding his spinal cord had been narrowed by an overgrowth of bone and ligaments that compressed his spinal cord at the neck, hence impairing his control of the muscles at and below that level. He was operated on in an attempt to decompress the spinal cord at his neck.

Unfortunately, the surgeon who operated on him accidentally dropped a bone nibbler - yes, an ominous name for a surgical instrument which nibbles away bone - on his spinal cord, thus damaging it. The operation was aborted immediately and the incision site was closed.

When Jack woke from anaesthesia, he was totally paralysed at and below the level where his spinal cord had been traumatised.

The surgeon explained the accident to him and sincerely apologised. Jack accepted the explanation and apology and forgave the surgeon. There was never any thought of a lawsuit.

Gradually, with the help of intensive physiotherapy - not to mention his determination - Jack regained strength but not dexterity in his body and limbs. He could walk but his muscles were stiff and often went into spasms.

Walking, for him, was so difficult and slow it was painful to watch. His hand and finger movements were also affected and simple tasks like buttoning his shirt were major efforts. In addition, he suffered severe, constant pain which got worse over the years.

He is a cousin of a close friend of mine who, five years ago, asked me to see Jack for a second opinion as to how his pain might be relieved.

I saw him, traced his medical records and suggested several options to reduce the pain and stiffness. Unfortunately, all of the options involved further surgery. At that time, he declined.

Since then, about twice a year, I would ask Jack whether he could come to the National Neuroscience Institute (NNI) to function as a subject for teaching purposes. He has never refused, but he could come only after work.

I was surprised that in spite of his handicap, he could still hold down a regular job. He takes the MRT to Novena station, and then walks slowly with the help of a walking stick to the NNI's outpatient clinic.

He patiently recounts the story of his ailment to each new batch of medical students. He allows me to demonstrate his abnormal muscle tone, his sensory perception and over-active tendon reflexes to the students.

Then, he patiently allows each of the 10 students to confirm these findings. When the tutorial is over, he declines any cash reimbursement for transport and walks painfully back to Novena MRT station to head home.

As he leaves, the students and I watch the slow and painful gait of this man who suffers daily, walking away with walking stick in his hand, dragging his legs which appear too stiff and heavy to lift off the ground.

I remind my students not only of the medical ailments we have just studied, but also of the bigger lesson in life: of a man who readily forgave the surgeon whose mistake caused him lifelong suffering; of a man who faces life with no bitterness or self-pity and makes the best of the circumstances he finds himself in.

More than that, he takes the time to come to NNI so that my students can learn from him. He does it because he is a good man, and also because I am his cousin's friend and he and I are now friends.

I remind my students that the problems they whine and bitch about are minor and transient compared to the problems my patient faces, with considerable dignity and courage, daily.

If he had received his injury in the course of defending Singapore, he would have been awarded a distinguished military award. But the injury was the result of a misfortune.

The courage with which he has faced the consequences of his injury is no less inspiring than if the injury had been incurred in the line of defending Singapore, and he is a hero. I hope the students who have interacted with him have learnt something about life and how to live it.

I have certainly learnt much from my friend, the most important being to accept what we cannot change and let go of anger and bitterness, for neither will help us. In fact, they are maladaptive as they cause distress and serve no purpose.

Finally, as we are discussing a medical problem, we must constantly keep in mind new medical or surgical treatments and technology that may solve a previously untreatable condition.

NNI has sent a bright neurosurgeon to train in functional neurosurgery in Toronto. Among the skills he will bring back are the latest techniques in pain treatment. I have discussed this with Jack, whose pain has become more severe over the years.

He is keen to discuss new treatment options. Realistic hope makes suffering easier to bear and I try to offer this whenever the option is available. It is amazing how much of our suffering can be influenced by our state of mind.


Dr Lee is the director of the National Neuroscience Institute.

Courage of an unknown heroine

The Straits Times Jun 2, 2009

By Lee Wei Ling

The housekeeper who cleans my room at the Singapore General Hospital (SGH) is a 46-year-old Kadazan woman from Sabah. She works every day, and is unfailingly courteous, cheerful and meticulous in her work. I struck up a conversation with her. Her name is Moiri, and life has dealt her a bad hand of cards.

Her husband died in a traffic accident more than 10 years ago when he was in his 30s. She has never been to school but has managed to single-handedly bring up her two children.

Initially, she farmed her land. But whatever padi, vegetables and chicken the farm yielded was barely enough to feed her family and she never grew enough to sell. Working as a cleaner in Sabah earned her RM300 a month.

She came to Singapore five years ago and works now for a cleaning company, ISS Facility Services Private Limited.

She works every day, including weekends and public holidays, so that she can earn overtime pay. She alternates between working from 7.30am to 11.30pm one day and from 7.30am to 3.30pm the next. She then supplements these normal working hours with overtime. As a result, she earns about $1,370 a month. She works on average about 67.4 hours a week.

She pays $100 a month for a room in an HDB flat at Spottiswood Park which she shares with four other women. She walks to and from SGH to her flat, thus saving on bus and train fares. After deducting the cost of her food, she has $900 to send back to Sabah each month.

She had breast cancer last year and had mastectomy and radiation therapy in SGH. I came to know about her illness because a close friend of mine was also admitted for mastectomy. When Moiri saw her doing her arm exercises, she encouraged my friend, saying she too had been through it and is now well.

ISS Facility Services' company health policy does not cover medical illnesses that are not work-related. In Moiri's case, her total medical expenses came up to about $4,600. The company paid her hospital bill because she had been a consistently good performer - did her job well, always turned up for work and had received numerous compliments from patients and customers. In addition, ISS also granted her two months' paid leave to recuperate.

SGH and ISS staff members voluntarily contributed about $2,000 to Moiri, which they gave to her as a hongbao, which she used for her follow-up treatments. The gift was a clear reflection of the fact that many who knew her, liked and trusted her. Moiri is very grateful to ISS as well as to the many friends she has made in Singapore.

Obviously, many people other than I have taken a liking to this cheerful Kadazan woman who accepts the bad hand of cards that fate has handed her, but chooses to play life's game as best as she can, with good spirit and with no self-pity or bitterness.

Moiri's 24-year-old daughter will be graduating from university this year and will proceed to a teacher's training college. Moiri intends to eventually put her 14-year-old son through university as well.

My friend and I have struck up a friendship with Moiri. She tells us she is happy to be among patients who smile at her and invited both of us to her 'humble' home in Sabah. She said she has peace of mind, happiness in her heart, and many friends in Singapore. What more could she ask for?

I was very touched by her remarks and the matter-of-fact manner in which she related her life story.

How many of us, who may have more than Moiri has, are as satisfied or contented as she? How many of us clamour for more, at the expense of happiness and friendship? How many true friends does each of us really have - friends who are not afflicted with the green-eyed monster? How many of us can do as much as Moiri has with so little, and yet not complain?

Moiri has never been to school, but she is wise. She approaches life with the Stoic philosophy, though she doesn't know about it. However adverse external circumstances are, our happiness is within our control. I may be crippled, but I can choose to hobble around cheerfully or allow myself to sink into deep depression.

I myself have been crippled by fractures five times between 2001 and 2005. Like Moiri, I had not heard of or read Stoic philosophy then. But I hobbled around on crutches at a pace that was faster than that of a normal young adult walking. One friend complimented me: 'You are getting very agile on crutches.' I replied: 'I have had a lot of opportunity to practise.'

Recently, I did read about Stoic philosophy. Epictetus, a Greek Stoic philosopher who lived in the first century, put it very eloquently thus: 'I must die. But must I die groaning? I must be imprisoned. But must I whine as well? I must suffer exile. Can any one hinder me from going with a smile, and a good courage, and at peace?'

In short, it's not what happens to you, but how you react to it that matters. People are not disturbed by particular events as such, but by the view they take of them. Moiri does not have formal education, but she knows how to live her life. She is a much happier person than many who are richer and more educated than she.


Dr Lee is the director of the National Neuroscience Institute.

Live to fight another day

The Sunday Times May 17, 2009

By Lee Wei Ling

At about 5am on Jan 25, I woke up because of a vivid dream.

I had dreamt that I had signed up for a commando course. To get to the place where the course was being conducted, I had to climb down an almost vertical cliff with no proper path or steps. I stared down the cliff and wondered how others who had signed up for the course would get down safely. At that point, I woke up and found myself in Singapore General Hospital. My ileostomy bag was almost full.

An ileostomy is an opening in the abdominal wall, from which the contents of the small intestine can trickle or pour out unpredictably. The intestinal content is faecal-like. Hence the need for an ileostomy bag.

Fortunately I had not turned to lie on my left, my preferred sleeping position but also where my ileostomy was. Hence the semi-fluid, smelly contents of the ileostomy bag had not leaked. I changed the bag and pressed the bell to get the nurse to clear away the mess.

The preceding day, I was not so lucky. There was a leakage.�I have highly skilled nurses looking after me in SGH. They took meticulous care in changing the wafer. The wafer is the base to which the ileostomy bag is attached. Changing the wafer is a tedious process that can take up to 30 minutes. Despite the excellent care of the nurses, the wafer often caused severe itching.

The background to my surgical problems in January was that I had a small perforation in my ileum or small intestine, where it joined the colon. Intestinal content contaminated my peritoneal cavity, or the space lined by peritoneum inside the abdomen. I had an operation to repair the perforation and clean up the peritoneal cavity. It was necessary to bring my small intestine out through the abdominal wall as an ileostomy, while we waited for the swelling and inflammation of my gut and any scar tissue to settle before joining the ileum and colon.

Most of my dreams are illogical and not related to my real life. But this particular nightmare may indeed have been symbolic of what I knew I was in for. The probable scenarios were not pleasant, but I intended to treat whatever happens as a commando course - a challenge.

On April 14, I had the surgery to reconnect my ileum to my colon, and close the ileostomy. As my condition was not a straightforward one, the procedure was performed by a team of excellent senior surgeons as well as experienced anaesthetists. My personal physician was also in the operating theatre.

The surgery went well. The post-operative discomfort lasted a mere few days. I am still recovering and will take a few more weeks to recover fully.

In theory, I can then go back to normal life. But I have had so many medical and surgical complications before that I prefer to visualise the worst case scenario and hope for the best.

The potential problems that I may encounter in the future include intermittent intestinal obstruction with abdominal pain and vomiting which may evolve into perforation or gangrene of the gut. I may need further surgery, more of my gut may need to be resected. I may not have enough gut left to sustain my nutrition by eating and I may need to be fed through the vein. I may also end up needing a permanent ileostomy. There are several other rarer but no less unpleasant scenarios which may follow the present surgical adventure.

None of the above complications was within my surgeons' control when they operated on my already battle-scarred abdomen.�As I described my nightmare in my journal at 5am on Jan 25, I reminded myself that no one promised me life would be fair or devoid of suffering.

I stopped seeing patients during the period of my illness because of the potential social embarrassment which might occur with ileostomies. I continued with my administrative duties from my hospital room. I got to know many of the nurses personally and one day I will write a column about this group of dedicated, skilled and caring women. A short mention does not do them justice.

Fast-forward to this moment: It is three in the morning as I write, having been awoken because of coughing which caused pain at the site where the ileostomy had been closed. The operation had gone well, but I have a premonition that my troubles are not over yet.

But life must carry on. Worrying about potential complications which may occur a few months or many years down the road is a waste of energy. After all, no one knows tomorrow; no one even knows the next moment.

Granted, my next moment is more unpredictable than for most; I personally think that that is an advantage. It helps put life in perspective for me. What should be done and can be done now, I always try to do immediately. My game plan is to try to do my best within the constraints I live under.

Using boxing as an analogy, there will be times when I am knocked out, the referee counts to 10 and I cannot get up. I will crawl to the ringside, lick my wounds, haul myself up, recuperate and return to the ring another day. At some point, after a severe knockout, I will no longer be able to enter the ring again. But until then, I will keep trying until I have completed my duties, or at least as many of them as I can.

For now, I am looking forward to the end of the present ordeal. It has been an interesting though not particularly pleasant experience since Jan 8. But as my friend Gino once told me, 'what does not kill you will make you stronger'.

I think I have emerged psychologically more resilient just as I hope the present poor economy and the threat of a flu pandemic will force Generation Y to become tougher.


Dr Lee is the director of the National Neuroscience Institute.

Why I choose to remain single

The Sunday Times May 4, 2009

By Lee Wei Ling

My father became prime minister in 1959, when I was just four years old. Inevitably, most people know me as Lee Kuan Yew’s daughter.

My every move, every word, is scrutinised and sometimes subject to criticism. One friend said I lived in a glass house. After my father’s recent comment on my lack of culinary skills, another observed: “You live in a house without any walls.” Fortunately, I am not easily embarrassed.

As long as my conscience is clear, what other people say of me does not bother me. Indeed, I am open about my life since the more I try to conceal from the public, the wilder the speculation becomes.

My father said of my mother two weeks ago: “My wife was...not a traditional wife. She was educated, a professional woman... We had Ah Mahs, reliable, professional, dependable. (My wife) came back every lunchtime to have lunch with the children.”

Actually, my mother was a traditional wife and mother. She was not traditional only in one respect: She was also a professional woman and, for many years, the family’s main breadwinner.

One of my mother’s proudest possessions is a gold pendant that my father commissioned for her.

He had a calligrapher engrave on the pendant the following characters: “xian qi liang mu” (贤妻良母) and “nei xian wai de” (内贤外德). The first four characters mean virtuous wife and caring mother. The second four mean wise in looking after the family, virtuous in behaviour towards the outside world.

My mother lived her life around my father and, while we were young, around her children. I remember my mother protesting gently once about something my father had asked her to do. “It is a partnership, dear,” my father urged.

“But it is not an equal partnership,” my mother replied. The partnership may not have been exactly equal at particular points in time. But over the years, especially after my mother’s health deteriorated after she suffered a stroke, my father was the one who took care of her.

She clearly indicated she preferred my father’s care to that of the doctors’, in itself a revelation of the quality of his care.

He remembers her complicated regime of medications. Because she cannot see on the left side of her visual field, he sits on her left during meals. He prompts her to eat the food on the left side of her plate and picks up whatever food her left hand drops on the table.

I have always admired my father for his dedication to Singapore, his determination to do what is right, his courage in standing up to foreigners who try to tell us how to run our country.

But my father was also the eldest son in a typical Peranakan family. He cannot even crack a soft-boiled egg – such things not being expected of men, especially eldest sons, in Peranakan families.

But when my mother’s health deteriorated, he readily adjusted his lifestyle to accommodate her, took care of her medications and lived his life around her. I knew how much effort it took him to do all this, and I was surprised that he was able to make the effort.

If my parents have such a loving relationship, why then did I decide to remain single? Firstly, my mother set the bar too high for me.

I could not envisage being the kind of wife and mother she had been. Secondly, I am temperamentally similar to my father.

Indeed, he once said to me: “You have all my traits – but to such an exaggerated degree that they become a disadvantage in you.”

When my father made that pendant for my mother, he also commissioned one for me. But the words he chose for me were very different from those he chose for my mother.

On one side of my pendant was engraved “yang jing xu rui” (养精蓄锐), which means to conserve energy and build up strength. On the other side was engraved “chu lei ba cui” (出类拔萃), which means to stand out and excel.

The latter was added just for completion. His main message was in the first phrase, telling me, in effect, not to be so intense about so many things in life.

I knew I could not live my life around a husband; nor would I want a husband to live his life around me. Of course, there are any number of variations in marital relationships between those extremes.

But there is always a need for spouses to change their behaviour or habits to suit each other. I have always been set in my ways and did not fancy changing my behaviour or lifestyle.

I had my first date when I was 21 years old. He was a doctor in the hospital ward I was posted to. We went out to a dinner party. I noted that the other guests were all rich socialites .

I dropped him like a hot potato. In 2005 , while on an African safari with a small group of friends, one of them, Professor C. N. Lee, listed the men who had tried to woo me. There were three besides the first.

Two were converted into friends and another, like the first, was dropped. I am now 54 years old and happily single. In addition to my nuclear family, I have a close circle of friends.

Most of my friends are men. But my reputation is such that their female partners would never consider me a threat. More than 10 years ago, when there was still a slim chance I might have got married, my father told me: “Your mother and I could be selfish and feel happy that you remain single and can look after us in our old age. But you will be lonely.”

I was not convinced. Better one person feeling lonely than two people miserable because they cannot adapt to each other, I figured. I do not regret my choice.

But I want to end with a warning to young men and women: What works for me may not work for others. Many years ago, a young single woman asked me about training in neurology in a top US hospital. I advised her to “grab the opportunity”.

She did and stayed away for eight years. She returned to Singapore in her late 30s and now worries that she may have missed her chance to get married. Fertility in women drops dramatically with age, and older mothers run the risk of having offspring with congenital abnormalities.

Recent studies show also that advanced paternal age is associated with an increased risk of neurodevelopmental disorders in offspring, such as autism and schizophrenia, not to mention dyslexia and a subtle reduction in intelligence.

Men can also suffer from diminished fertility with age although there is wide individual variation.

I would advise young men and women not to delay getting married and having children. I say this not to be politically correct.

I say it in all sincerity because I have enjoyed a happy family life as a daughter and a sister, and I see both my brothers enjoying their own families.


Dr Lee is the director of the National Neuroscience Institute.

The day Michael Fay saved me from jail

The Sunday Times Mar 22, 2009

Even in the US, some believe that giving up a bit of freedom can serve the greater good

By Lee Wei Ling

Someone e-mailed me an article from the San Francisco Chronicle titled 'Singapore blooms as lush as Eden itself'*1, by Linda Watanabe McFerrin, about our city in a garden.

'Unfortunately, what most Westerners know about Singapore,' she notes, 'is limited to the restrictions imposed on its citizens by a repressive government that dictates the mix of races; regulates reproductive matters, public housing and other seemingly personal matters; bans chewing gum, canes kids and keeps a stranglehold on the media.'

I read the article with amusement and recalled the day Michael Fay saved me from being thrown into jail in New Hampshire. For those too young to remember Fay, let me relate his story.

In 1993, the then 18-year-old and his friends damaged 18 cars in a 10-day spree of vandalism and mischief. Stolen road signs and Singapore flags were also found in his home. Fay was caught, charged and pleaded guilty. The judge sentenced him to six strokes of the cane and four months in jail.

The American media went berserk; then US President Bill Clinton appealed to then President Ong Teng Cheong to pardon the teenager; the Singapore Government agreed to reduce the sentence to four strokes of the rotan; the US media was not satisfied.

At the time of his arrest in Singapore, Fay was living with his mother and stepfather. On his release from prison in June 1994, he returned to the US to live with his father.

A few months later, the US press reported that he had come home intoxicated late one night and had charged at his father. A month later, he was badly burnt sniffing butane when a friend struck a match.

He admitted that he had been a butane addict while in Singapore.

Fay was far from my mind when I spent three wonderful days hiking in the White Mountains of New Hampshire in October 1995.

It was fall and the mountains were covered with red, yellow, rust and gold foliage with tiny flecks of green - a work of art which no human painter can ever equal either in magnitude or splendour.

Just before heading back to Boston, I stopped at a tiny souvenir shop. I bought a sweatshirt with a moose printed on it for my mother.

I then saw a T-shirt with the New Hampshire state emblem, the head of an eagle, and the words 'Live Free or Die' printed around the emblem.

I have always avoided wearing anything which makes a statement. But I could not resist buying this T-shirt. Then I hit the highway again, heading for Boston.

The highways in America are wonderful. They are multiple-lane affairs, with a physical separation between the traffic going in opposite directions. This makes speeding on them safer than in Singapore.

Soon, I was cruising at 195kmh with Scottish music playing at full blast in the background.

Because of the loud music, it took me some time before I noticed a police siren and slowed down.

With its red, white and blue lights flashing, the police car overtook my vehicle and signalled for me to pull over. I did so and the police car stopped ahead of me.

The policeman walked over to my car, demanded to see my driving licence, then yanked me out, saying: 'I am bringing you to the police station to be locked up.'

I protested: 'I was only speeding. I will pay the fine and you should let me off.'

He shot back: 'You were not only speeding. You disobeyed the law by not stopping immediately when I flashed the light to signal you to stop.'

He shoved me into his car and drove off, leaving my rental car by the roadside with all my belongings, including my newly purchased T-shirts, in it and the car door still open.

He radioed back to the police station, saying he was bringing someone in to the lock-up.

'What do you work as?' he asked me.

I replied: 'I am a doctor.'

'I hope you are a better doctor than a driver. Are you on drugs?'

'No. Do I look as though I am on drugs?'

'No, you look as though you were concentrating on overtaking every car ahead of you.'

That was indeed what I was doing. How often in Singapore can one drive at 195kmh? But I chose not to voice that thought.

Suddenly he asked: 'What do Singaporeans think of Americans?'

I replied quite sincerely: 'We like Americans. Hewlett-Packard, IBM and other multinational companies create jobs for us. But you probably don't like Singaporeans because we caned Michael Fay.'

His whole demeanour changed when I mentioned Fay.

'Michael Fay deserved to be caned,' he said firmly. 'He has been causing trouble since he returned to the US.'

He told me how his best friend, also a policeman, had been shot point-blank and died that morning when he stopped a speeding car. That was why he was in such a foul mood.

From that point on, our conversation got friendlier. We talked about hiking in New Hampshire, how we drove on the left in Singapore and so on.

Without my realising it, he had turned around and had driven back to where my rental car was. A tow truck had just arrived, but my policeman shooed it away.

He walked me to my car, told me to 'drive safely' and walked off. He did not fine me, nor did he charge me for activating the tow truck.

I drove back to Boston hardly believing my good luck.

American journalists may flog Singapore because of its perceived limitations on personal freedom, but there are some Americans - even in 'Live Free or Die' New Hampshire - who feel that a compromise in personal freedom to prevent anti-social behaviour is necessary for the welfare of society.

Most Singaporeans and many Americans would agree with that sentiment.


Dr Lee is the director of the National Neuroscience Institute.

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*1 Singapore blooms as lush as Eden itself

San Francisco Chronicle Mar 1, 2009

By Linda Watanabe McFerrin

"Ah, that fragrance is beautiful, like gardenia or tuberose."

I am standing in a perfectly groomed Eden, a few feet away from a tumbling waterfall, gazing into the dark eyes of a man who looks both ancient and young.

"It is a butterfly lily," he explains. The white blossom is perfectly reflected in the black eyes of Rahman Salleh, grounds manager and my guide through the gardens of Shangri-la.

No, not the legendary Himalayan lamasery and paradise celebrated in James Hilton's 1933 novel "Lost Horizon," but a hotel in Singapore, the first property in a luxury chain built on the principles of the lush utopian kingdom.

A breeze rustles the fronds of the fishtail palms, giving their long, Rasta-look seedpods a vigorous shake. We continue our walk through the oasis, past fan and hurricane palms, delicate gingers, past the waterfalls, koi ponds and pools where pleasantly braised and toasted guests loll. All have beatific smiles on their sun-dazed faces. So do I. I've come to Singapore, after an absence of many years, to rediscover paradise - the lush, leafy heart of a nation better known for its obsessions with commercial success. I think I've found it here. But this is not the only slice of heaven in this land of sunlight, flowers and friendly people.

Singapore is, in many ways, a little miracle. Young by any standards - the 273-square-mile island nation is only 43 years old - although it is a little over a quarter of the size of Rhode Island and is one of the most crowded countries in the world (around 16,000 residents per square mile), it is also one of the cleanest and most picturesque, and its gross domestic product ranks high. Its ethnically and religiously diverse people - mostly Chinese, Malay, Indian - are well-educated and live and work in apparent harmony. English is the universal language in Singapore, though Mandarin Chinese, Malay, Tamil and others deemed "mother tongues" are also taught and studied.

Unfortunately, what most Westerners know about Singapore is limited to the restrictions imposed on its citizens by a repressive government that dictates the mix of races; regulates reproductive matters, public housing and other seemingly personal matters; bans chewing gum, canes kids and keeps a stranglehold on the media. Westerners know that it's commercial, that its citizens are materialistic, and that the food and the shopping are great. I must admit, headquartered in the towering pagoda of the Singapore Marriott on Orchard Road, where the swell of humanity ebbs and flows above and below ground through high-rise department stores and high-end boutiques, this assumption seems accurate.

But beyond this, beyond the rules and the regulations and the obsession with making and spending money, is another Singapore, a Singapore as graceful and gracious as the mythical utopia that Hilton conjured for readers, a place that I, like Hilton's hero, Conway, never leave without a pang of longing.

Partly it's the people. The Singaporeans I have met are swift: quick in business, quick to learn new things and quick to welcome you. But another reason I love the place is the order and harmony that is one of the outcomes of the nation's strict governance. Even in the midst of massive urbanization and modernization, Singapore has managed to retain much of its tropical island ambience. Ten percent of the country's limited space is devoted to green zones: to parks and nature areas. And then, of course, there are the islands.

Singapore, itself an island separated from the Malaysian mainland by the Strait of Johor, is surrounded by 35 smaller islands. Boomerang-shaped Pulau Ubin, a mere 10 minutes away by bumboat, is a little less than 4 square miles of abandoned granite quarries, coconut and rubber plantations, mangrove and coastal forests, seagrass lagoons and rocky shore. It is home to some of Singapore's last traditional villages, or kampongs, and to the beautiful Chek Jawa Wetlands, where anemones, cowries, volutes, sea stars, sea horses and a myriad of other forms of rarely seen water and land life abound. You can rent a van to take you about the island, but the best way to see Pulau Ubin is to rent a bike when you arrive or set out on foot along one of the many trails that traverse it. Stop for a cold chrysanthemum tea along the way or join schoolchildren, families and others for a quick bite at one of the island's tiny trailside eateries.

It takes a little longer to get to Kusu Island. Access is by ferry, which sets out from the Marina South Pier and stops at sleepy St. John's Island. Once a quarantine facility for lepers, today St. John's draws visitors interested in family outings, a quiet shoreline stroll or an intimate seaside picnic. Kusu or Tortoise Island is a bit busier. Every year, at a certain point in the lunar calendar, nearly 90,000 Taoist devotees make the trip to Kusu to pay homage and pray for the five blessings: longevity, wealth, tranquility, health of body and peace of mind. The rest of the year it is peaceful, with little to distract from the stunning seascapes. Legend has it that a giant sea turtle turned itself into this island to save two shipwrecked sailors, one Chinese, the other Malay. Today its offspring are everywhere. On my recent visit, I threw a few wishful coins into the lotus in front of Tua Pekong Temple, climbed the 152 steps to Kramat Kusu, the Muslim shrine that sits at the high point of the island, and communed with the turtles. Their message was clear: Slow down.

Other islands around Singapore include Subar Laut (Big Sister Island) and Subar Darat (Little Sister Island), named for two beautiful sisters, Minah and Lina, who escaped kidnapping by jumping into the sea; Pulau Hantu, which is great for diving; and Pulau Satumu, another top diving location. It is surrounded by rich coral reefs, and the lighthouse on the island is more than a century old.

Perhaps the most popular, though, is Sentosa Island. If there is a fantasy island, I believe this is it.

You can take the expressway to get to Sentosa or you can swing into the scene on the aerial cable car, which will drop you off in Imbiah right next to the Butterfly Park and the Insect Kingdom. Rasa Sentosa, on Siloso Point on the western end of the island, is a beachfront property with a playful Disney-like atmosphere. With its long white beaches and round-the-clock activities, it's a favorite of Singaporean families and visitors who want to go from zero to a hundred and back again in a few short steps. If the Underwater World, Flying Trapeze, Luge and Skyride, Fish Reflexology spa (where the fish nibble dead skin off your feet) or friendly pythons don't grab you, try a little beach volleyball, a snooze on the sand or a cocktail at one of the numerous restaurants, lounges and seaside cafes. Peacocks and monkeys roam the grounds as do blissed-out children and adults.

Further inland, on the eastern side of the island, the Sentosa Resort & Spa, adjacent to Sentosa Golf Club, caters to a more serene crowd. The resort is home to Spa Botanica, one of the most luxurious in Asia, where clients are treated to a wide range of therapies, indoors and out. Massages, scrubs, baths, body wraps, manicures, pedicures, scalp treatments - every imaginable therapy is on the menu. The pampering takes place indoors (private rooms) or outdoors (exquisite personal pavilions). You can opt for hours of hands-on relaxation or you can spend the day at leisure, wandering amid the frangipani and ferns on the facility's tropically landscaped grounds, enjoying the tea house, swimming pools, cascading waterfalls, volcanic mud pool, meditation labyrinths, float pools, whirlpools and inviting umbrellas of shade.

Returning from Sentosa to Singapore Island does not mean you have to abandon the sense of island calm. It's always mere minutes away in a country and city where colorful districts like Chinatown and Little India are tucked in between great clouds of green. Chief among these and a must for anyone who wants to really feel the green pulse of this carefully landscaped city, is Singapore Botanic Gardens. Established in 1859, these gardens precisely illustrate the close connection between the world of nature and the well being of humanity and exemplify the balance that Singapore's leaders mean to preserve. This is, after all, where 'Hevea brasiliensis,' or Para rubber, was first grown and cultivated in Asia, introducing a crop that would transform the region's economy and usher in a new era of prosperity and modernization.

It is also home to major developments in orchid breeding and hybridization. The National Orchid Garden is a riot of vibrant color, sometimes laced with the faint smell of vanilla, which happens to be an orchid as well. Like the other gardens in the 155-plus-acre complex of lakes, meadows, kiosks, information centers and cafes, they are not simply eye candy; they instruct. The Botany Center located near Tanglin Gate at the park's entrance is an education center that houses important resources like the Singapore Herbarium, the Library of Botany and Horticulture and the Orchid Breeding and Micropropagation Laboratory.

For all their beauty, the Singapore Botanic Gardens are not about romantic notions of nature; they are about the inter-relationship of man and his environment, and in that sense, they are - like just about everything in Singapore - pragmatic. This is nature with a purpose, and that purpose, in some worldviews, is to serve man, just as man's purpose is to be an able and responsible steward of the natural world. This philosophy is explicit throughout the park: in gardens that highlight the commercial contributions of the vegetable kingdom, trace the evolution of plants or teach children to create and explore in a flowering world; in the careful integration of people-friendly structures and meticulously maintained landscapes and in the property's promotion as a popular attraction. Admission to just about everything is free. In the morning, the park is full of parents and children, dog walkers, joggers, cyclists, martial arts practitioners, friends, lovers and a few savvy tourists.

I could spend months in those gardens and possibly years becoming more familiar with Singapore's 300 large and small parks. But, as luck would have it, my trip led elsewhere.

My final day in Singapore was spent at HortPark, the gardening and lifestyle hub of the island country. In this 56-acre regional park full of greenhouses, flower marts, display plots, floral walks, galleries, activity centers and event lawns, the community coalesces around horticultural and landscaping issues, from preparing a new, young generation of gardeners, to greening the Singapore of the future. Some of my last heady moments on the island were spent in the midst of that vision as I sat listening to a short lecture on the National Parks Board's latest ecological adventure.

Their proposed Gardens by the Bay community will occupy around 250 acres of prime waterfront land designed to frame urban dwellers in a serene mantle of ecologically balanced, technologically supported and sustainable greenery.

Among the features under development are Cool Conservatories, massive multi-acre, all-weather glass structures that will showcase flora using sustainable energy technologies. In the Gardens at Marina South, SuperTrees - 98- to 180-foot structures each covered with a living "skin" of greenery - will function very much like natural trees, housing photovoltaic cells in their canopies and collecting the rainwater essential to the Cool Conservatories, even as they provide shade and visual beauty for the people who move beneath them.

The developments go on and on, all focused on marrying technology and nature for the betterment of man. Artificial or not, it's a wise direction in our use-it-or-lose-it day and age. Sitting there, amazed, it occurs to me that what they are doing here is re-engineering Paradise. In Singapore, they are not so much bemoaning a lost horizon as finding a new one.


Poet, travel writer and novelist Linda Watanabe McFerrin (www.lwmcferrin.com) writes frequently about the natural world.

The day I failed an examination

The Straits Times Mar 5, 2009

By Lee Wei Ling

In February 1982, I took my MRCP part 2 in Edinburgh. The MRCP exam is the postgraduate examination for internal medicine and paediatrics organised by the College of Physicians in Britain. Three universities conduct the examination simultaneously - London, Glasgow and Edinburgh.

I chose to take my examination in Edinburgh because I was not sure I could understand London's Cockney accent or the Glasgow accent. The Edinburgh accent, I figured, would be much easier for me to understand.

I was down with flu at the time of the practical examination in which we were supposed to examine patients. I was told to listen ('auscultate') to the heart of my first patient. I guessed what she had but could not hear the corresponding heart murmur. From then on, my examiners became unfriendly and I became nervous.


When the examination was over, I went back to the hospital where I had examined the patient and asked her mother what was wrong with the patient. I had guessed correctly: She had a mitral stenosis, which causes a murmur that is notoriously difficult to hear.

Nowadays, doctors no longer need to have acute hearing in order to diagnose heart conditions. A cheap and simple ultrasound produces clear anatomical pictures, including of heart functions. No more guessing is required.

I was sure I had failed the examination though I had sailed through the written paper and the subsequent viva voce. When the results were announced, I was in the Royal College of Physicians of Edinburgh building. After the crowd had thinned, I went forward to read the list of names.

Mine was not on the list.

The news spread like wildfire among the Singaporean medical community. 'Lee Wei Ling has finally failed an exam! She is like any one of us.'

I took my failure very badly because I knew I did not deserve to fail. I did not even need the MRCP as I already had my Master of Medicine (in paediatrics), which is on equal footing with the MRCP.

I was also hurt by the fact that many Singapore doctors seemed happy I had failed. I swore to myself that I would not take the examination again.

But my father told me: 'You have to take that exam until you pass it. You have to prove to Singapore you can do it.'

My parents have never pressured me or my brothers to aim for academic success. If there was any 'pressure', it was no more than an implicit expectation. This was especially so with me, the most highly strung and stubborn of their three children. I was determined to prove I could equal my brothers' academic achievements.

All my previous examination successes - except for the one doctors need to pass to practise in the United States - had occurred in Singapore. For all written medical examinations, local or foreign, one wrote only one's index number on answer sheets.

So there was no question of examiners favouring me because I am Mr Lee Kuan Yew's daughter. But my father nevertheless wanted me to show Singaporeans that I could succeed outside of Singapore, though success in the MRCP examination is to a small but significant extent dependent on luck.

So I returned to Edinburgh to re-take the MRCP in October 1982. This time I took great care not to catch any bug, and I went up to Edinburgh by train wearing a face mask.

Everything went smoothly and I knew I had passed. Indeed, I knew more about the patient - a young child with brain damage - than the examiner. I returned to London after the examination and asked a friend to telephone me the results. After I received confirmation that I had indeed passed, I phoned home.

Ming Yang, my late sister- in-law, picked up the phone. I asked her to tell the rest of my family that I had passed. And I asked about her new baby.

She told me he was an albino. Hsien Loong was a little disappointed and had told our father the boy would not be able to do national service. I also knew that albinos have poor eyesight. My heart went out to Ming Yang and Loong.

I flew back to Boston, where I was based then. While napping after my arrival, my father phoned me. 'Ming Yang passed away of a heart attack,' he reported. 'Come back now.'

I returned to Singapore for Ming Yang's funeral and stayed to mark the new baby's first month.

My father arranged my return flight to Boston. As he believed flying west was less tiring, I flew through London and stopped there for a day. Since then, London has always brought back unhappy memories for me and I avoided going there until 2004, when I needed to meet someone in Edinburgh.

As luck would have it, his house was but a street away from the Royal College of Physicians of Edinburgh building. After our meeting, I walked right up to the front door of the building. The building was locked since it was a Sunday. I stood there for a few minutes, before turning to another friend who had accompanied me and said: 'Red dust.' (A Chinese expression signifying the illusions of life.)

Twenty-seven years later, my examination failure seems inconsequential. But I have no regrets having tried and failed the first time. It made me appear normal to the Singapore medical community.

Also, considering how outspoken and aggressive I can be, a failure that lent me a vulnerable image did me no harm. My failure forced me to learn how to roll with the punches and to react to life's capriciousness with equanimity.

As for my albino nephew, he has grown into a kind, considerate and responsible young man who is not ashamed of being different from the average man in the street. He too has learnt to accept what he cannot change and to adapt his life around the constraints.

Life is unpredictable for all of us. But if we persevere and adapt, many apparently impossible difficulties can be overcome. That my nephew will graduate soon from the National University of Singapore is proof of that fact.


Dr Lee is the director of the National Neuroscience Institute.

Slump time has arrived

The Straits Times Feb 2, 2009

By Lee Wei Ling

In 2007, in an end-of-year message to the staff of the National Neuroscience Institute, I wrote: 'Whilst boom time in the public sector is never as booming as in the private sector, let us not forget that boom time is eventually followed by slump time. Slump time in the public sector is always less painful compared to the private sector.' Slump time has arrived with a bang.

While I worry about the poorer Singaporeans who will be hit hard, perhaps this recession has come at an opportune time for many of us. It will give us an incentive to reconsider our priorities in life. Decades of the good life have made us soft. The wealthy especially, but also the middle class in Singapore, have had it so good for so long, what they once considered luxuries, they now think of as necessities.

A mobile phone, for instance, is now a statement about who you are, not just a piece of equipment for communication. Hence many people buy the latest model though their existing mobile phones are still in perfect working order.

A Mercedes-Benz is no longer adequate as a status symbol. For millionaires who wish to show the world they have taste, a Ferrari or a Porsche is deemed more appropriate.

The same attitude influences the choice of attire and accessories. I still find it hard to believe that there are people carrying handbags that cost more than thrice the monthly income of a bus driver, and many more times that of the foreign worker labouring in the hot sun, risking his life to construct luxury condominiums he will never have a chance to live in.

The media encourages and amplifies this ostentatious consumption. Perhaps it is good to encourage people to spend more because this will prevent the recession from getting worse. I am not an economist, but wasn't that the root cause of the current crisis - Americans spending more than they could afford to?

I am not a particularly spiritual person. I don't believe in the supernatural and I don't think I have a soul that will survive my death. But as I view the crass materialism around me, I am reminded of what my mother once told me: 'Suffering and deprivation is good for the soul.'

My family is not poor, but we have been brought up to be frugal. My parents and I live in the same house that my paternal grandparents and their children moved into after World War II in 1945. It is a big house by today's standards, but it is simple - in fact, almost to the point of being shabby.

Those who see it for the first time are astonished that Minister Mentor Lee Kuan Yew's home is so humble. But it is a comfortable house, a home we have got used to. Though it does look shabby compared to the new mansions on our street, we are not bothered by the comparison.

Most of the world and much of Singapore will lament the economic downturn. We have been told to tighten our belts. There will undoubtedly be suffering, which we must try our best to ameliorate. But I personally think the hard times will hold a timely lesson for many Singaporeans, especially those born after 1970 who have never lived through difficult times. No matter how poor you are in Singapore, the authorities and social groups do try to ensure you have shelter and food. Nobody starves in Singapore.

Many of those who are currently living in mansions and enjoying a luxurious lifestyle will probably still be able to do so, even if they might have to downgrade from wines costing $20,000 a bottle to $10,000 a bottle. They would hardly notice the difference.

Being wealthy is not a sin. It cannot be in a capitalist market economy. Enjoying the fruits of one's own labour is one's prerogative and I have no right to chastise those who choose to live luxuriously.

But if one is blinded by materialism, there would be no end to wanting and hankering. After the Ferrari, what next? An Aston Martin? After the Hermes Birkin handbag, what can one upgrade to?

Neither an Aston Martin nor a Hermes Birkin can make us truly happy or contented. They are like dust, a fog obscuring the true meaning of life, and can be blown away in the twinkling of an eye.

When the end approaches and we look back on our lives, will we regret the latest mobile phone or luxury car that we did not acquire? Or would we prefer to die at peace with ourselves, knowing that we have lived lives filled with love, friendship and goodwill, that we have helped some of our fellow voyagers along the way and that we have tried our best to leave this world a slightly better place than how we found it?

We know which is the correct choice - and it is within our power to make that choice.

In this new year, burdened as it is with the problems of the year that has just ended, let us again try to choose wisely.

To a considerable degree, our happiness is within our own control, and we should not follow the herd blindly.


Dr Lee is the director of the National Neuroscience Institute.