How the 'kiss of life' gives the gift of life

26 Sep 2007, ST, Mind Your Body

CPR is key in saving the lives of people in cardiac arrest. Elaine Young finds out why more people should be trained in it

Three weeks ago, 44-year-old Mr Neo Tze Siong made the news when his life was saved by three strangers who gave him cardio-pulmonary resuscitation (CPR) after he had had a heart attack.

A few days later, however, 10-year-old Jonathan Chow Kin Mun's life ended after he fell into a pool, even though he had received CPR from his father.

Why did CPR work for one and not the other?

Unlike the image portrayed on medical dramas, survival with the 'kiss of life' is not guaranteed.

But it is crucial to improving one's chances of surviving should the heart stop suddenly.

According to Singapore General Hospital, each year in Singapore, about 2,400 people develop acute heart attacks, 1,000 suffer from sudden cardiac arrest out of the hospital and another 400 have sudden cardiac arrest after reaching the hospital.

But only one in five people who suffers a cardiac arrest receives CPR, noted Mr Robin Tan, chief trainer at SGH's Life Support Training Centre.

The total survival rate for pre-hospital collapses is about 2.6 per cent.

If the victim is to have a chance, the Chain of Survival, developed in 1990 by the American Heart Association (AHA) must be swiftly followed. This protocol addressed the fact that most sudden cardiac arrest episodes occur outside a hospital, with death occurring within minutes. There are four links in the chain: early recognition and access, early CPR, early defibrillation and early advanced care in hospital.

To be effective, each link in the chain has to be executed quickly. With each minute that passes, the chance of survival decreases by up to 10 per cent.

The most common reason for a person to die suddenly from cardiac arrest is heart disease. Other causes of cardiac arrest include foreign body obstructions in the airway, drowning, stroke, suffocation, smoke inhalation and electrocution.

During a heart attack, the heart continues to pump blood, but part of the organ does not receive any blood because of a clot which suddenly and completely blocks blood flow to the heart.

If the person who has a heart attack collapses, is not breathing and has no pulse, then it is a cardiac arrest. This is when the heart rhythm becomes rapid or chaotic, so it cannot pump oxygenated blood efficiently to the brain, lungs, and other organs. This is known as ventricular fibrillation. The victim quickly stops breathing and loses consciousness.

'A person who has sudden cardiac arrest has very little time before brain damage occurs - approximately four minutes - so time is of the essence,' said Dr Lim Chong Hee, senior consultant at the department of cardiothoracic surgery at the National Heart Centre of Singapore.

The idea of CPR is to get the circulation going 'artificially', he explains. This includes providing mouth-to-mouth resuscitation and chest compression.

Chest compression mimics heart contractions and mouth-to-mouth mimics breathing, by delivering oxygen to the lungs via the mouth.

CPR is the second link in the Chain of Survival. It is the link that can buy life-saving time between the first (early access to emergency care) and third link (early defibrillation).

To defibrillate the heart is to give it an electric shock which stops it, so it can restart.

According to the AHA, few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of the collapse.

Said Dr Lim: 'CPR can restore normal heart rhythm, especially when you are able to institute defibrillation.'

There are some risks to CPR: Even if done correctly, it could result in complications such as fractured ribs. It should also not be attempted if the person is still breathing and has a pulse, but mistakes are minimised if the rescuer is properly trained in CPR.

It is also not as effective without defibrillation but it helps to buy time by getting blood to the brain and other organs before emergency paramedics arrive, said Dr Lim.

All emergency civil defence ambulances are equipped with automatic external defibrillators (AEDs), which are portable electric shock devices. At the moment, these are not widely available - at about $3,000 per kit, that is perhaps no surprise - but this is another goal for the Singapore Heart Foundation.

Said Mr Muhammad Khair, executive officer of community education with the foundation: 'These machines are already in clinics, hospitals and ambulances but we would like to see them in every shopping centre, HDB void deck and MRT station.'

In tandem with getting more AEDs into the community, the foundation wants to see half the Singapore population - up from the current two in 10 - trained in CPR and in the use of AEDs over the next three years.

About 30,000 people, mainly health-care professionals and emergency workers, receive CPR training here every year. But that includes those who take the refresher course after two years.

This number is woefully small, considering 90 per cent of sudden attacks occur either at home or in public places, so a person's best chance of survival could be from a family member or stranger.

Said Dr Lim: 'CPR training is easily accessible and should be promoted as public education.'

Dr Patrick Tan from the Singapore Red Cross Medical Commission concurs: 'The public mindset must change from apathy and the belief that learning CPR and AED is other people's responsibility.

'Everyone should make it a point to learn CPR and AED. Don't wait for an emergency to happen and regret not knowing what to do to save a life.'

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Chances of survival

The chances of survival range from zero to 43per cent, depending on the type and speed of attention:


No care after collapse
0%

No CPR and delayed defibrillation
(after 10 minutes)
0 to 2%

CPR from a non-medical person
(bystander or family member)begun within two minutes,but delayed defibrillation
2 to 8%

CPR and defibrillationwithin eight minutes
20%

CPR and defibrillationwithin four minutes; paramedichelp within eight minutes
43%

------------------------------------












The general sequence of CPR (not all steps are shown): First, establish unresponsiveness by tapping the casualty on the shoulder.

Then, check for foreign objects in mouth, and flick any out with index finger. Check for breathing and feel for the flow of air from the casualty’s nose moving past your cheek. If victim is not breathing, give two short breaths and allow for lung deflation between breaths.

Finally, interlace fingers as shown, use body weight to compress chest. Perform 30 compressions.

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CPR courses

The National Resuscitation Council was established in 1998. It is the accreditation body for all cardiac life support training centres in Singapore.

The National Heart Centre website (www.nhc.com.sg) lists all the accredited CPR Training Centres. Here are some heartsaver courses on offer for the public:


>>Changi General Hospital
Training Centre
Duration: 4.5 hours
Cost: $52.50
Course outline: CPR guide. Theory and practical test.
Inquiries: Call 6850-2360 or go to website www.cgh.com.sg


>>Singapore General Hospital
Life Support Training Centre
Duration: 3 hours
Cost: $53.50
Course outline: CPR guide. Participants can go on to do the four-hour AED course on the afternoon of the same day. Theory and practical test.
Inquiries: Call 6326-6884 or e-mail lstc@sgh.com or go to website www.sgh.com.sg


>>Singapore Red Cross Society
Training Centre
Duration: 8 hours (includes 120 minutes for lunch/breaks)
Cost: $90
Course outline: CPR guide. Theory and practical test.
Inquiries: Call 6336-0269 or go to website www.redcross.org.sg

The drive to survive

16 Sep 2007, ST

It takes more than sheer will to stay alive - knowing what to do in a testing situation is important, too

By Huang Xueling

CALL it a miracle or the never-say-die determination to survive.

Recently, newspapers have run stories about people hanging on to dear life in adverse situations and who were eventually rescued.

Take the case of brothers Meng Xian- chen and Xianyou, both in their 40s. They stunned everyone when they dug their way out of a caved-in coal mine in China, using only bare hands and a small pick, 130 hours after the incident which occurred about a month ago.

Or Ora Doris Anderson, 76, who was found alive, albeit with a hip injury, in the Oregon wilderness 13 days after the American had gone missing on Aug 24.

Further back in April 2005, good friends Troy Driscoll and Josh Long, now 17 and 20, were found six days after the Americans were stranded at sea on a 15ft boat off North Carolina, with no food or water.

The general consensus among medical experts is that humans can survive for several weeks without food and three days without water.

In any extreme situation, the most important factor for survival, apart from oxygen, is water.

According to Dr Bryan Chua, deputy director of Nanyang Polytechnic's School of Health Sciences, water constitutes a major component of the human body and has several important functions, 'including acting as a solvent and a medium for chemical reactions'.

Indeed, in the above three cases, all the survivors found a way to hydrate themselves.

The Meng brothers drank their own urine.

Mrs Anderson was said to have taken water from a stream near where she was found.

Driscoll and Long sipped rain water off the bow of the boat and gargled their mouths with seawater.

But sea water should never be drunk as it causes electrolyte imbalance in the body, which together with dehydration, can be fatal, says Dr Chua.

'Rain water and stream water would be the best alternatives. Look for running water, and observe if other animals are drinking from this source,' he advises.

Dew collected on plants is also a viable alternative.

Food, while not as essential as water, is important as extreme hunger can induce irritability and low morale.

'We've energy reserves in our bodies which can be utilised during times of starvation. As the reserves are depleted, the person will experience physical and psychological symptoms such as weakness, lethargy, irritability and confusion,' says Dr Chua.

The Mengs had no food and it is not known if Mrs Anderson ate anything, but Driscoll and Long ate about a hundred jellyfish.

Dr Chua says mammals and birds are generally safe for consumption if they can be caught or trapped. Some fish and reptiles are also edible.

'Some fruit and seeds can also be eaten but wild berries and mushrooms may be poisonous,'' he reveals.

It is best to observe what the animals eat.

Survival books give this tip: When you are consuming unfamiliar foods, start with a small quantity and observe over the next few hours for any reactions like rashes, vomiting, abdominal pain or breathing difficulties.

'For individuals intending to go on adventurous expeditions, it is advisable for them to learn about basic survival skills and carry a survival guide with them,' Dr Chua says.

Experts say holding out in extreme conditions depends on the person's state of fitness and health, as well as environmental conditions such as temperature, cloud cover and rainfall.

A person should try to maintain a normal body temperature as it is essential for metabolic processes to function optimally.

In a cold environment, the body may not be able to produce sufficient heat and risk suffering from hypothermia.

As the body temperature falls, vital functions such as breathing and heart beat slow down, and may lead to unconsciousness and death.

Still, however dire the situation is, the person has perhaps one last card to play - the emotional and mental strength, or will, to fight to the last.

Driscoll and Long, who were stranded in the middle of the ocean, had no shelter from cold winds at night, pouring rain and hot sun in the day.

Driscoll's body was reportedly so badly sunburnt that he had second-degree burns and his feet suffered from hypothermia, which left all the nerves in them dead.

But they hung on.

And that explains why you continue to read stories about people beating seemingly insurmountable odds to live and fight another day.

The simpler life

8 Sep 2007, ST

By Valerie Tay

SOME have wondered how my family of six manages on the single income that my husband, the sole breadwinner, brings home. Guess I could share a few tips that have been serving us well.

I'm well qualified to do so as, like some of our ministers, I handle several portfolios too. In addition to being the Minister of Home Affairs, I'm also the Minister of Education and the Minister of Finance at home. Besides juggling four kids, I also juggle the family budget and make sure I do just as good a job as Prime Minister Lee Hsien Loong does with the national budget, if not better.

Even if you do not find the tips I'm about to share enlightening, who knows, you might find our money-saving ways worth-a-laugh ridiculous. I know I'm still laughing at how I can put $17,000 worth of Further Tax Rebate to use since I'm not working and my spouse isn't allowed to use it.

As sure as ERP rates will keep going up, this rebate will go up in smoke too, when it expires in 2009. I'm reminded of some of the gifts I used to get during the annual office Christmas gift exchange when I was working - people do give you things you're unable to use.

Let's forget that ridiculous bit for now and focus on some really helpful tips.

First of all, the easiest thing to do is increase the size of the pie - I write freelance (and I enjoy it). It pays peanuts but, hey, it's better than nothing.

Second, we drum it into our kids that money doesn't grow on trees, nor does it pop out from the wall after pressing a few buttons. Dad has to go to work just so there's money in the bank. And besides all the new things that we buy for our kids, they also use their cousins' handed-down clothes, bikes, toys and textbooks.

Next, it helps tremendously that we've always lived on one income even when I was working and we enjoyed dual incomes in the past. We believe in living within our means by living simply. Better still, preferably slightly beneath our means, as it means that we will have a little more to put aside.

The best thing we had going for us has always been achieving zero debt - consciously and conscientiously. We drive an old car. I still remember the used-car agent's surprise when we declined a loan and wrote him a cheque for the entire sum, which wasn't much really, given that the car was a decade old.

We've entertained the idea of condo living but eventually dropped it. The thought of shouldering the burden of a long-term commitment to a new home loan put us off, and so we stayed on in contentment in an HDB flat that's fully paid for.

We use only one credit card as our brain tends to ignore the total expenditure when the figures look deceptively smaller spread out in several card statements. Our credit card bill is paid promptly by Giro. Never roll over any balance.

Another advantage of using just one credit card is in pooling the reward points earned. Always use the card instead of Nets where possible, to chalk up more points.

Direct as many bills, such as phone, Internet and newspaper subscriptions, to be paid through the card as possible.

Our no-annual-fee Maybank credit card has rewarded us with vouchers to purchase groceries at NTUC Fairprice. When shopping at Fairprice, consolidate purchases so that it hits at least S$20, at which point you earn Linkpoints which can be redeemed for Fairprice vouchers. In a year, we redeem over $100 worth of vouchers to offset our grocery bill. A family of six does eat a lot!

We don't have cable TV. Less TV means more time for kids to play imaginatively (with Lego, for example) and read voraciously.

For holidays, we travel at most twice a year to nearby destinations. We certainly can't afford to fly a family of six long-haul on one income now. In March, we drove up to Desaru for a weekend break. This December, we're heading for Krabi as we took advantage of Tiger Air's early-bird promotion. I can already smell the opportunity to make some extra bucks for the travel story that I could write on our return.

I'm not into trust funds or Reits. Being ignorant of the jargon, I just go for blue chip stocks, the ones they call dividend stocks. I can already hear the hyena-like laughter of the savvy ones out there, but who cares? I love the fact that I have pocketed thousands of dollars from dividends.

After all is said, there are always inherent risks in whatever stocks one picks (this line is to cover myself in case someone out there takes what I say seriously, only I don't put it in fine print like all those product pamphlets). Don't listen to me. I'm just a housewife - what do I know about investing?

That said, you shouldn't listen to your financial adviser or other 'experts' either. Take whatever they say with a dose of salt.

Forget about booking courts. When we feel like playing tennis or badminton, my son pops his head out to check if the public multi-purpose court across the street is being used. Often, it is available and we grab the sports bag and hightail there.

Four times a year, we make our pilgrimage to Johor Baru during the school holidays. The advantage of driving an old car like ours is that no car thief is interested.

When in JB, we eat and shop and eat, in between paying a visit to the hairdressing salon, sports shop, hardware store, pharmacy, dentist, bakery, Carrefour, mooncake shops, roadside cobbler, car workshop and, of course, the petrol station.

We had the boys' room repainted recently using paint picked up from JB. Forget about getting painters - we do the walls ourselves, one wall a time. The hubby and I do the Tom Sawyer on the kids. Heh, heh... they can't wait for their turn with the roller.

Before you run off and buy everything you see in JB, do note that not everything is cheaper over there. Arm yourself first with the knowledge of prices of stuff you need. Let's run that by again - stuff you 'need', not 'want'. There's, um, quite a difference.

Lastly, let me share with you this wonderful phrase I read in the papers, spouted by a Caucasian Zen monk (if I remember correctly): Our life is clouded by obsessions and desires. These desires distract us from the path of light. Om.

Okay, that last word didn't come from the monk. My life is a little simpler compared to some people I know. I don't have a lot of desires, so I am largely contented and happy. Still, it is not as simple as I would like it to be.

Far from it. I'm still working on fighting the little desires.

I haven't yet got to the utopia that is truly where living a simple life is. And I don't mean the place that Paris and Nicole put up at.

Though I know I'll probably never really get to that true utopia, but even if I should inch just a little closer with each passing year, I'm happy to keep on working on simplifying my life further. Wish me luck.

No, better still, why not have a go at it, too?

The writer is a full-time mother who has just started to do freelance writing.

Living in hope

6 Sep 2007, ST

A young mother infected with Aids finds the courage to aim for a better life for her daughter

By Loh Keng Fatt

HER name is Ana. Infected with HIV at birth, she learns early to hide her ailment from others. But she gets to know a boy and, at 17, becomes a mother.

Her life story of standing up to tough times is recounted by Jenna Bush, daughter of United States President George W. Bush, in Ana's Story: A Journey Of Hope.

The two met when Bush, 25, was on an internship with Unicef in Latin America and the Caribbean, and came into contact with young people infected with Aids.

Here is an excerpt from the book, which zooms in on Ana's desire to do better for herself and her daughter, and the difficult decision she has to make regarding the father of her child, the Aids-infected Berto.

'Things became more and more difficult between Ana and Berto. He had left the hospital and returned to the hogar (home) but they hadn't spent much time together.

She always had to visit him because it was difficult for him to get around. She felt bad for him, sad he was in pain but she also felt lonely watching other couples walk hand in hand with their children.

She was surrounded by families but although Berto was the father of her baby, she did not feel they were a family of their own.

Ana's feelings for him were unpredictable. When she thought of the love they shared in the beginning of their relationship, she wanted to be with him forever.

When she thought of Beatriz, she wasn't sure that he could be the type of father that she wanted for her daughter.

When they were together, he seemed more interested in Ana than Beatriz; it seemed as if he wanted to be a boyfriend, not a father. Ana wanted a family for her daughter. She wanted to give her everything she hadn't had.

In many ways, he was still her best friend but she didn't have the same feelings for him that she used to. The passion, the attraction, the butterflies had flown away.

Instead, she found herself thinking of Guillermo. Berto was and would always be Beatriz's papa but Ana knew what she had to do. She didn't want to hurt Berto but she had to tell him how she felt. Her palms sweating, she dialled the number of the hogar.

'Hola, Berto,' she said nervously. 'Hola, Ana. What's up? How is Beatriz?' he asked.

'Beatriz is good; I am good too,' she said as she cleared her throat. 'Berto, there is something I need to talk with you about. I know I've been acting weird.'

'Ana, it's fine,' he said. 'I understand.'

'No, Berto, it's not okay.' Ana paused, unsure of how to say it. Then she blurted out. 'You will always be Beatriz's papa but I don't think we are working as a couple.'

There was silence on the phone line.

'I wasn't expecting this at all,' he said. 'I don't want this. I don't want Beatriz to live the life that I have lived, without a mama and a papa. I am her father.

'I would do anything to make this work, to be a family, a real one,' he said.

'Berto, you can't. You don't have a job. You still live in the hogar. You need to be there and Beatriz and I can't live there with you. How can we be a family when we can't live together?' she said. 'I'm sorry but my feelings have changed too.'

'Okay,' was all he said, then he hung up. She felt a combination of grief and relief. She didn't regret what she had done but she did regret that Berto would not be able to be the kind of father Beatriz needed.

Ana and Berto still wanted the same future - one with a loving and supportive family - but she no longer saw the two of them living that dream together.'

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# Ana's Story: A Journey Of Hope is available in major bookshops at $28.

# Books For The Soul is a weekly column that highlights books which move, comfort or inspire.

I keep what's mine

30 Jul 2007, ST

One day, when I'm old and have Alzheimer's, the things I hoard may help me remember who I was

By Suzanne Sng, girltalk

SOME of my prized possessions include a doll that was part of my mother's dowry, a book of fairy tales that my father bagged in Primary 4 for being first in English, and a worn and battered set of luggage that my parents used on their honeymoon.

I also have my childhood Lego bricks and little yellow people, my massive Enid Blyton book collection proudly displayed on shelves and the first baby clothes I ever wore hung up on a tiny hanger.

Tucked in the back of my cupboard are boxes with autograph books from long-lost classmates, love letters from past boyfriends and a haphazard stack of yellowed newspaper clippings (and this column will be the latest addition to it).

As you may have guessed, I am a bit of a hoarder. I have a severe inability to throw anything away. Ever.

From observing my Mum, my sister, my aunts and my girlfriends, I realise that women seem to keep more - for want of a more precise word - stuff. From a purely pop psychology point of view, I'd say women are more sentimental.

Men, on the other hand, have what they term collections - smelly sneakers, vinyl records that haven't been spun for years and action figurines still sealed in their original packaging.

The stuff women keep, however, fall into a variety of categories.

There is the sentimental stuff, such as my family memorabilia and childhood favourites. Friends always get a trip down memory lane when they see the Famous Five and Secret Seven books lining my bookshelves and wonder why they allowed their Mums to give theirs away.

Then there are the clothes, which easily make up one huge category by themselves and take up the entire back of the wardrobe.

At least for me it does, and I know I'm not alone in stashing away fashion disasters, impulse buys and other clothes which I'll never fit into again in this lifetime.

Almost every woman has one unworn item lurking in her cupboard, probably with the price tag still on. It can't be thrown away, because that is too wasteful.

Giving it to someone else is not an option, not until you've worn it at least once. And so it remains hanging there, together with the pair of jeans that cuts off blood circulation to your lower body and the party frock that has outlived a doomed love affair.

The jeans give hope of regaining the 24-inch waist of your youth, and the dress represents the nostalgia of love lost. Never mind that both are sadly out of reach.

Speaking to a good friend with whom I share remarkably similar habits, we find that we both have an affinity for hoarding pretty but useless things. In other words, they're pretty useless.

Delicate tealight holders and candles. Mooncake boxes with intricate chinoiserie designs. Vases that never fulfill their life purpose because no one ever buys us flowers. I can't imagine a guy clinging on to these knick-knacks or having problems trashing them. In the first place, he wouldn't acquire something simply because it looks so pretty.

Other popular items for compulsive hoarding fall into what I call the auntie category. Or, as my Mum would say: 'Keep, in case.'

These include the ubiquitous oily food containers you get when you do a takeaway from the coffee shop, mini bottles of harsh shampoo and bars of hand soap snitched from hotels, tattered wrapping paper from Christmases past and more supermarket plastic bags than you can ever use. (Insert 'Save the earth' slogan here with exhortation to switch to cloth totes for groceries.)

Psychologists say that hoarding is the reflection of anxiety and the sign of a troubled mind. I say it is just a case of being a little overzealous about the virtue of saving.

The experts also say that the urge to collect may derive from the need to store supplies such as food.

It originates in the subcortical and limbic portions of the brain, which I'm not sure refers to which part of my head, but it does make me feel better about the shelves of Tupperware in my kitchen. In case of war or famine, I will be able to store a lot of food.

In a recent fit of decluttering, I removed the equivalent of 10 boxes of 'stuff' from my bedroom - and placed them in the living room instead. I thought it would be the perfect opportunity to weed out the rubbish, but all I managed to throw out was an InStyle magazine circa 2004.

I know of a fellow pack rat who is in despair that her apartment has gone en bloc because she has decades' worth of earthly belongings to sort through before the move.

Despite my attempts to relegate some of my prized possessions to junk status, I couldn't bear to do it. They may not be worth much money or even mean anything to someone else, but they are precious to me.

Whenever I see self-help books that trumpet that decluttering your home will also help improve your life, I scoff. My quality of life will only plummet if I don't have the comfort and security of the things I love around me.

Deciding that since my decorating style is maximalist (as opposed to a minimalist), I even installed more shelves and bought a new bed with additional storage underneath for hoarding purposes.

I make no apologies for the fact that I'm a sentimental fool.

The stuff I keep all have memories associated with them, good or bad. One day, when I'm old and have Alzheimer's, they may help trigger my brain to remember who I was. And that is why I keep them.

When nobody takes the trouble to ask

30 Jul 2007, ST

By Valerie Tay

THE right ear had turned a bright red, a stark contrast from the left. Still, the teacher tugged forcefully on the ear as the rest of the class winced.

The boy grimaced in pain but not a sound issued from his lips.

'Why didn't you do your homework?' the cikgu screamed, her anger getting the better of her. She gave the ear another vicious tug and I feared it was going to come off. Thankfully, it didn't but its colour deepened to a darker crimson.

The boy stood silent, hanging his head. He didn't look frightened, just kind of resolute and resigned, like he had accepted his fate.

And that had been his daily fate on a school day. Hardly a day passed when he was not berated, had his ear pulled or had his exercise book thrown in his face.

Think it's fiction? No, I witnessed those scenes countless times when I was in primary school.

If I remember correctly, his name was Chin Huat and he was always getting into trouble because he hadn't done his homework.

I could never understand why he couldn't just do his homework and avoid the humiliation and pain. Like my teachers, I'd thought I'd never seen a lazier fellow and a more hopeless case.

Then one Friday night, on a whim, my mother took me to the Haig Road hawker centre for supper. We had settled down to eat at a table when I spotted him.

Chin Huat, no longer in his school uniform, was busy at one of the stalls, serving customers and clearing tables. I watched him for a while, awed by this different side of him that I'd never seen before.

He was very efficient at his job, multi-tasking and quick on his feet, and instead of the usual quiet and sullen-faced boy I knew in school, he looked happy, smiling frequently. A confidence shone on his face like he knew he was in his element here.

It was past nine. It dawned on me that the stall wouldn't close till late as the food centre was still packed with people and business was brisk. There was a middle-aged couple busy manning the stall as well. Was Chin Huat helping out at his parents' stall? Did he come here to work every day after school?

I thought about all the homework that hadn't been done and I finally knew. That very moment, I learned that, sometimes, things aren't what they appear on the surface.

Our eyes finally met. I nodded and gave him an encouraging smile. He seemed embarrassed for a moment, before a holler from the stall brought him to a start and he resumed his duty.

With the understanding, a new respect took root in my heart. I was a lucky kid, while not so lucky kids like Chin Huat went to work after school. Overnight, my perception of him turned 180 degrees. I was the cloistered child, he was an adult living in the real world. I admired him.

He didn't last till the Primary Six exams, dropping out of school after a few more months of ear-pulling. There was no point - he wouldn't have passed.

He'd definitely be happier taking to work life like a responsible adult. And if he inherits his father's hawker stall, I know he will do well and not have to owe anybody a living.

But why hadn't he told the teacher? Explain why he could never find the time or energy to do his homework? Why didn't he say anything to anyone? For years I couldn't understand his reticence - till one day, I found myself in a Chin Huat situation.

Working as an executive in a large company, I was sent to a four-day workshop held at a hotel. Classes started at 9am every morning.

The first day I managed to arrive only at 9.30am. The trainer made some remarks about punctuality and continued his presentation. Of course, everyone knew the comment was directed at me.

The next day, I arrived at 9.30am again. The trainer repeated his call for punctuality, seemingly to nobody in particular, again.

I wasn't late on purpose. It was simply no use leaving the flat earlier. On a normal working day, I'd arrive at the office at 8.45am instead of the required 8.30am. I had sought the understanding of my supervisor and he had kindly agreed to let me start work 15 minutes later and finish work later.

You see, every morning, I would be at my son's PCF kindergarten at Bedok Reservoir (where my mother lives) waiting for the teacher to open the door at eight, drop him off and then rush off to work. I could make the office in 45 minutes by bus. My mother, who doesn't get up till 9am, would pick my son up after school.

The workshop's location was further than the office. I had to take a bus, then switch to the train, to get there. That was why I arrived at 9.30am.

I thought of telling the trainer about my situation, but decided to wait and see if he would take me aside to talk about it. No such luck.

My colleagues, too, did not ask, and I, too, did not explain.

The third morning, the trainer made another exhortation for punctuality. But by then, I had grown irritated and stubbornly refused to go to him to explain.

I also pushed aside the thought of taking a taxi to the hotel. Why should I spend the equivalent of a tin of formula milk to gain the approval of the trainer? I'll admit I do have a wilful streak in me.

Then came the last day of the training, and he took his revenge. Oh, he'd saved the best game for the last.

Taking one end of a long piece of string, he invited a participant to hold the string a little distance away from him. That participant would then invite someone else, and so on, in the great string communion.

It was obviously a popularity contest, and no prizes for guessing who would be last. I stood there waiting till the end and, in a way, I deserved it.

The trainer let a long pause develop before coolly asking the pariah standing alone, 'Would you like to join in?'

'Sure,' I replied, just as coolly, with a smile. 'I don't mind.' And I stepped up smartly, confidently, to grasp the end of the string, unrepentant and defiant to the end.

I thought about Chin Huat then, and I finally understood what I had failed to understand all these years.

Chin Huat hadn't spoken of his problem because no one had asked. No one had cared to ask. Sometimes, things may not be what they appear to be.

Next time I see a Chin Huat, I think I'll ask.

The writer is a full-time mother who has just started to do freelance writing.

I thought about Chin Huat then, and I finally understood what I had failed to understand all these years. Chin Huat hadn't spoken of his problem because no one had asked. No one had cared to ask. Sometimes, things may not be what they appear to be.

Kiam chye soup for the soul

29 Jul 2007, ST

By Tan Hsueh Yun

A FRIEND told me a few nights ago that I have a 'kiam chye mia'. Translated from Hokkien, this pungent little phrase means that I have a 'salted vegetable life'.

I'd never heard of such a thing but my friend said it meant I was a loser. Make that Loser with a capital L.

Six of us were at dinner and someone asked what I'd been up to. I had just come back to work after being on leave for two weeks and moaned about spending the second one sick with a fierce bug.

All the plans I made had to be cancelled because all I could do was sleep and cough, cough and sleep.

People I've told this to, and I've told everybody I can think of (blame my inner drama queen), are usually sympathetic and I've come away realising that this sort of thing is pretty common.

Mr Kiam Chye himself often gets a cold or falls sick when the weekend comes around and is convinced that he'll be too ill to work on Monday. Inevitably, Monday rolls around and he's right as rain, having spent his precious weekend being ill.

Someone else at the table, who was on leave from work, developed a cough in the first few days of his liberation.

Other people told me it is pretty much a given that when they're out of the office for any length of time, they immediately come down with some bug or other.

I tried to ignore my sore throat at first, taking fistfuls of bright pink Chinese tablets that are supposed to tame throat inflammations. They worked, I congratulated myself and went about my business, packing my days with lots of stuff.

But one Monday morning, I woke up feeling like I had just swallowed a box of nails.

'Your throat looks nasty and I don't like the sound of that cough,' Doc Chia said and offered a medical certificate that would allow me to rest at home.

Don't need one, I griped. I'm on leave. He looked at me with pity. I was outraged, fit to be tied. You would be too if you had to spend the remaining week of your leave doped up, achy and miserable.

In truth, I should have turned that outrage on myself because I allowed it to happen.

A therapist who ironed out some kinks in my back some time ago said that people like me put off resting or taking care of our well-being until we can get time off. So when that time comes around and we can relax, the body takes its revenge.

I know all this. Earlier this year, a bout of the flu saved me from a long and torturous bout of insomnia I'd pretty much inflicted on myself.

But I didn't learn my lesson.

My reasoning is that when you are younger, you think you can do anything with impunity and so you are a bit reckless. When you're older, you realise time is marching on and you want to pack as much into your day as possible.

But being good and conscientious sounds terribly boring, and I guess I'll have to find a way to push the boundaries without actually busting through them.

One good thing though, is that I have stopped feeling resentful about falling ill because I obviously needed the painful kick in the behind that it provided.

It helps that despite everything, I managed to do quite a lot of what I wanted to do.

There was a paella lunch I cooked for my parents and two of their friends, complete with a tray of gooey brownies for dessert. It felt good to spend quality time in the kitchen and for an appreciative audience to boot.

On a weekday morning, I had time to wander through Tekka Market, one of my favourite places in Singapore, without having to hurry or jostle with the crowds. And there I found, to my utter delight, Momotaro tomatoes twice the size of the ones usually found in supermarkets. They were heavy, ripe and sweet. It was like winning 4-D.

I managed to catch up with two friends who were visiting from out of town.

And then there was all that sleeping, which heaven knows I really needed.

People say that when life hands you lemons, you make lemonade. Well, when life hands you kiam chye, make kiam chye soup. There's nothing complicated about it - you simmer the pickled mustard greens, a chopped up duck, some peppercorns and tomatoes or sour plums in water for a couple of hours until the flavours meld. But like most simple dishes, it takes some finesse to get right.

If you don't trim the duck well, the soup gets too oily. That sludgy layer of oil floating on top coats the throat in a nasty way. Overdo the pickled vegetables, sour plum or tomatoes and the soup is unpleasantly tart, instead of being pleasantly zingy.

I guess kiam chye soup is a lot like life. Getting it right means finding just the right balance.

But I have to say the balancing act is a lot easier when you're not coughing up with phlegm.