Lee Wei Ling: Nobody knows tomorrow

Lee Wei Ling: Nobody knows tomorrow

By Lee Wei Ling, for the Sunday Times, 01 Mar 2009

The Straits Times carried last week a story about a group of Singaporeans whose rented minibus had careened off the highway and plunged down an embankment near Milford Sound in New Zealand.

Two passengers had to be airlifted to hospital. The most seriously injured was a 59-year-old woman who fractured her spine, arm and collarbone and required surgery.

Police believe that the driver was driving too fast and may also ‘have been distracted by the spectacular view’. Those injured had not worn their seat belts.

The report brought back memories of my own close brush with death on Dec 23, 1995. I was on a hiking holiday in New Zealand, having arrived in Christchurch the preceding day.

A car rental company had delivered a brand new Holden direct from the factory to my hotel on the morning of Dec 23. I drove across Arthur’s Pass to Punakaiki (Pancake Rocks) on the west coast of South Island. After walking around a scenic lookout, I drove south along the coastal road to Greymouth, where I had reserved a motel room.

On my right, a sheer drop thousands of metres below, was the azure Tasman Sea. On my left was the mountain, into the sides of which the road with hairpin bends was carved. I kept one eye on the road and the other on the sea with its pounding surf. The scenery was magnificent.

Suddenly, I noticed a road sign - ‘30km/hr’ - just before a very sharp bend in the road. I stepped on the brakes. The next moment, the car was spinning out of control.

‘Damn it, what an inconvenient place to have an accident,’ I thought as I pictured in my mind’s eye the car on the ocean bed, divers trying to cut open the car door, people leafing through my wet passport, and the Singapore High Commission in Wellington telephoning my parents in Singapore.

The car crashed into the mountainside with such tremendous force it turned 180 degrees. The front of the car faced the road, while the rear end was ramped up the mountainside as it slid into the ditch beside the road. If I had not had my seat belt on, I would have been flung against the windscreen. Instead, to my astonishment, I was totally unharmed.

My next problem was to get the car out of the ditch. I walked down to a village a few kilometres from the site of the accident and went into a house that had its door wide open. A man appeared in response to my loud ‘Hello, hello’.

After hearing my story, he fetched a thick rope, drove his car to the site of the bashed-up Holden, tied his car to it and managed to tow it out of the ditch. He then test-drove the Holden. He told me that I could drive the short distance to my motel but to be careful because the bonnet was no longer secure and might at any moment spring up and obscure my vision. I thanked him profusely and thought to myself: ‘New Zealanders are kinder than Singaporeans. I am not sure I would have done the same if our situations had been reversed!’

I got to my motel safely but found that there was no vacancy for Dec 24. By hook or by crook, I had to get the rental car replaced and drive on to my next motel near the Franz Josef and Fox glaciers the next day.

Next morning, the rental car company replaced my car and I continued on the rest of my holiday as planned. I was pleased with myself for having been calm and cool throughout the episode and had no intention of letting my parents know what had happened.

On Dec 31, I returned to Singapore as planned. When I arrived at Changi Airport, I phoned my mother and said: ‘Hi Ma, I am home safe.’ A few weeks later, my cousin told me that my mother had subsequently said to her: ‘Something happened to Ling on that trip. I’d rather not know what.’

My mother knew me better than I knew myself. She sensed that the phone call from Changi Airport indicated that I must have encountered danger during the trip.

I have been hiking since my youth, usually alone. By hiking alone, I break the first rule in any hiking book. I know the risk I am taking. I always calculate my risks. Where hikes are concerned, I balance the pleasure of solitude, the beauty of nature and the physical challenge of the hike against the risks of each particular route, as determined by the terrain and the weather. I have had many close calls but the incident in New Zealand was the closest.

My hiking and my occupation as a doctor bring home to me the saying that no one knows tomorrow; in fact, we don’t even know our next moment. I go hiking alone, courting danger, yet fate has spared me many times. On the other hand, while safely in Singapore, medical mishaps have on several occasions put me in very precarious situations.

The two lessons of this story that I hope to share with readers are:

To not wear a seat belt in a moving vehicle is foolhardy. Why risk life and limb unnecessarily? I go hiking alone because I like the thrill of taking on nature single-handedly and to prove to myself that I am not a coward. An analogy would be why people risk their lives climbing Mount Everest. But one proves nothing by omitting to wear a seat belt other than that one is foolish.

Never put off till tomorrow something that one can and should do today. There may be no tomorrow.

Lee Wei Ling

The writer is director of the National Neuroscience Institute

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Life with the Lees

Feb 1, 2009

Life with the Lees

Ouyang Huanyan looked after MM Lee's household from the 1940s. Mavis Toh and Lim Ruey Yan report

		PM Lee Hsien Loong as a child, posing for a photograph with a maid.
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In 1945, Madam Ouyang Huanyan found employment as a housekeeper with a Lee family.

Never did she expect the eldest son of the family to eventually become the Prime Minister of Singapore.

She also witnessed the wedding of Mr Lee Kuan Yew and Madam Kwa Geok Choo, his classmate from Cambridge University. It was a simple affair where relatives were invited to dinner.

This anecdote and others are published in a book titled Zishu Nu From Shunde, by China Women Publishing House in 2006.

It features the history and stories of Madam Ouyang and other women who left China to work as housekeepers and nannies in South-east Asia in the early 1900s. They all came from the Shunde district in Guangdong province.

The book came to the attention of National Neuroscience Institute chief Lee Wei Ling recently. Dr Lee, Mr Lee's daughter, told The Sunday Times that a friend had chanced upon the book while visiting a village in China.

In one of the chapters, Madam Ouyang, now 91 and still healthy (see box below), recounted her life in Singapore.

Born in 1918, she left her hometown in Cangmen at the age of 14 to join her sister in Singapore.

They were women - known variously as majie, zishu nu and amah - who took vows of celibacy so they could commit to serving their masters, and were a common sight then.

Her first employer was the famous Tan Kah Kee, a rubber magnate and Chinese community leader who gave money to start numerous schools. But she had no idea who he was. Her sister was already working in the household.

The Tans thought highly of the Ouyang sisters. When Japanese troops invaded Singapore in 1942, the Tan family had wanted to leave together with the sisters, but Madam Ouyang's sister did not want Madam Ouyang to go to a faraway place as she was still young. The Tans left their youngest daughter in the care of the two women as they fled the country.

After the war, so grateful were they to the women for keeping the girl safe that Mrs Tan asked the sisters to live with the family. Recalled Madam Ouyang in the book: 'She said, 'I've always treated you sisters like my daughters, please stay'.'

But by that time, Madam Ouyang was already working for the Tans' neighbour - the Lee family.

Mr Lee Kuan Yew returned home from his studies in Britain during her second year with the family. She witnessed his wedding - a simple affair where relatives were invited to a meal to celebrate the occasion.

Madam Ouyang recalled that although Mr Lee's home was big, it was furnished simply 'and was in fact a little bit old'. She and the other workers felt at ease there because the family was friendly and warm.

She remembered how Mrs Lee, a lawyer, was especially kind to the majie. She once told them: 'We're busy in the office and will arrive home late, so please have your meals first and do not go hungry. You can prepare the dishes after we get home from work. Everyone will not be inconvenienced this way. Is it all right?'

Hence, the practice in the household was for the workers to eat before the employers.

Most of the workers in the Lee household came from the Pearl River Delta because Mr Lee felt that they were 'well-disciplined, refined and hardworking'.

The family also welcomed other majie when Madam Ouyang invited them over for chats and visits. Mrs Lee addressed them as 'jie' (sister) and Madam Ouyang would feel a sense of pride.

Even after Mr Lee became prime minister, his style remained simple, she remembered.

She recalled that the maids used to address Wei Ling by her name. When Mr Lee took office, Madam Ouyang started addressing her as 'Da Xiao Jie', a term used for the employer's eldest daughter.

But the young girl told her sternly: 'It's my father who's the prime minister, not me. So please address me by my name.'

The Lees often took her on their outings so she wouldn't be cooped up at home. As she watched Mr Lee hold the hands of his children, Madam Ouyang felt that the prime minister was more like a patient father and a friendly friend. 'Someone you can trust and be at ease with.'

Mr Lee also valued tradition. She recalled one Chinese New Year where he ordered a set of mandarin jackets for the children.

She added that he told his elder son Hsien Loong: 'We are Chinese, so we should follow the traditional customs when celebrating the Spring Festival.'

In the late 1980s, Madam Ouyang returned home to Cangmen due to her poor health. She often received letters from Dr Lee inquiring about her health and asking her to return to Singapore.

Dr Lee, who still refers to Madam Ouyang as 'Yan Jie' today, had been raised by her since young. She told The Sunday Times that Madam Ouyang's voice was strong when she phoned her last year.

'She said her nieces and nephews were taking good care of her,' said Dr Lee. 'She remembers all the time with us and invited me to stay and visit.'

Having worked under two historical leaders, people are always interested in hearing about their stories from Madam Ouyang, noted the book.

But in her eyes, her employers were ordinary people. 'The only difference is that they were very busy, working constantly with hardly any time to rest,' she said.

She added that her encounters with the historical figures have made her life memorable.

'I have not lived my life in vain,' she said.

mavistoh@sph.com.sg

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Lee Wei Ling: What keeps me rooted to Singapore

Lee Wei Ling: What keeps me rooted to Singapore

By Lee Wei Ling, for the Sunday Times
01 Feb 2009

This is an era when international mobility is a privilege that many of our bright young men and women enjoy. The world is their oyster.

They were born and raised in Singapore. Some may have completed their tertiary education here, while others did so overseas. But I have cousins whose children have chosen to exchange their pink Singapore identity cards for United States passports.

If ever there is a major crisis in Singapore, those who would be able to emigrate, be accepted by another country and get jobs there would invariably be people who are wealthy and/or professionals with marketable skills.

The Government knows that talent is mobile and that Singapore must compete with other countries to offer an attractive living environment and vibrant culture so as to retain talented Singaporeans and attract foreign talent here.

I am a paediatric neurologist. I can pass any medical examination that Canada, the US, Australia or New Zealand may impose before accepting me as a high-skilled immigrant or ‘exceptional alien’. Would I take such opportunities?

Perhaps in a moment of madness, when my yearning for hiking outweighs all the other factors that keep me in Singapore and make me want to fight for it if the need should arise.

I have been fortunate in having true friends in Singapore. They and my nuclear family are the main reason I will stay if foreign armies invade or bombs are dropped on Singapore.

In 1975, the year South Vietnam fell, I was a medical student training in paediatrics. Paediatricians are especially kind and decent people, for only such people would be drawn to work mainly with children. Still, there was serious talk of emigration among my paediatrician mentors. One did emigrate with his entire family.

My parents called a family meeting in their bedroom soon after Saigon fell. My father, Mr Lee Kuan Yew, then Singapore’s Prime Minister, told us: ‘Mama and I will stay here to the bitter end. Hsien Loong is already in the SAF and must do his duty. But the three of you need not feel obliged to stay.’

In the end, the Vietnamese communists did not march down Peninsular Malaysia, Singapore thrived, Hsien Yang followed Hsien Loong in accepting both the SAF and President’s Scholarships, and my brothers both served out their bonds.

I myself had accepted a President’s Scholarship in 1973 to study medicine at the University of Singapore. It was a five-year course for which the Public Service Commission paid me approximately $3,000 to $4,000 annually. Most of it went towards my medical school fees. I was bonded for eight years.

Subsequently, I accepted several more scholarships from the Government and have served a total of 16 years of bond. I stayed on in the public sector after completing my bond and am now in my 31st year in service. I have also had the opportunity to live and study overseas for four years. I enjoyed living in North America.

As a nature lover, I appreciated the magic of the seasons. I enjoyed observing spring trying to announce its arrival with crocuses that may subsequently be buried by a late spring snowfall.

Spring in its full-blown splendour of trees, with budding leaves in the most tender hues of green…The daffodils…The cherry blossoms in full bloom along the Charles River in Cambridge, Massachusetts…Running alone at first dawn or twilight, as petals fluttered down on you, was a magical experience.

Then fall with its burst of colours, turning what was an almost uniformly green landscape into a tapestry of yellow, gold, rust, red and green that met your eyes as you jogged. And then winter announcing the end of the year - time to go cross-country skiing or find an indoor track to run.

The changing seasons enhanced the quality of life in a way that only someone who has lived in New England for three years, as I did, can appreciate. But I always returned home. I never doubted that home was anything other than Singapore.

I suffered a serious surgical complication on Jan 9 and am now recuperating in Singapore General Hospital as I write this.

I was in pain earlier this afternoon and, unable to do much, I dozed off. When I woke, my friend Gino was quietly sitting in the next room.

He had brought along with him brand-new running shorts and socks. I had messaged him at noon to ask him to get them for me but did not expect him to do so immediately. Gino is an excellent physiotherapist who helped me through an extremely difficult rehabilitation in 2002. We have been close friends since.

He had recently resigned from the Singapore Sports Council and we discussed the best location for him to set up shop. He gave me a sports massage and we chatted for some time until I felt up to doing my step aerobics.

This morning, one of my cousins dropped by, followed by my doctor-friends from the National Neuroscience Institute.

I am now staring at the skyline that I had stared at from the same window in 2002 and 2003. Then as now I was hospitalised for prolonged periods because of serious surgical accidents, which I later pulled through against great odds.

There are many more tall buildings now than there were in 2002 and 2003. This is a city-state. I am unlikely ever to go hiking again - in Hawaii or Bhutan, Kerala or New Zealand - my one and only real hobby.

What keeps me rooted here are my nuclear family and my friends. We enjoy good times together and help and support one another during bad times. They - rather than Olympic medals or National Day Parades - are the main reason why I feel this place is home and why it is worth fighting for if the need should arise.

The idea of dying does not scare me. But to be willing to stay on and fight for Singapore - that goes beyond simple logic. It is the result of the emotional bond I have with those who are important in my life as well as with those for whom I feel a sense of responsibility.

Lee Wei Ling

The writer is director of the National Neuroscience Institute.

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Heart-attack care: Transparency the best policy

Heart-attack care: Transparency the best policy

January 25, 2009

ST letter by Ms Lee Wei Ling

IN MY column, ‘Righting a wrong comes from the heart’, last Sunday, I described the status of treatment of acute myocardial infarction (AMI) in the public health-care sector. I stated the facts which were accurate up to Jan 1 this year. I felt that both the public and general practitioners (GPs) should have the relevant information about the capabilities of all our public-sector hospitals.

I wrote about it because my medical school classmate, a GP, was flabbergasted when I told her that Tan Tock Seng Hospital had no round-the-clock capability to open up obstructed heart arteries by ‘ballooning’ on an emergency basis.

Another medical school classmate, a specialist in the private sector, was forced by the SCDF ambulance to have her mother admitted to Tan Tock Seng last month and there was no doctor capable of doing ballooning on an emergency basis until she found one to do so.

Alexandra Hospital had no such capability and my classmate advised all her patients to go to the nearest hospital if they suspect AMI. She subsequently obtained feedback from other doctors that the ballooning service at Changi General Hospital was not great. I chose not to mention Changi General Hospital in my column, nor did I say that ‘only the National Heart Centre and National University Hospital are able to handle heart-attack patients after office hours’.

But in yesterday’s report, (’Most hospitals offer 24/7 heart-attack care’), Tan Tock Seng Hospital, the Ministry of Health and the Singapore Civil Defence Force seem perturbed by what I wrote.

Instead of looking forward to improving care of AMI patients, all three organisations expressed unhappiness about this public disclosure.

My view is that the public will be understanding and forgiving if they know this is the best service the Government can provide, given the various constraints. Giving the public the knowledge means AMI patients can make an informed and wise choice when deciding where to go for treatment.

Prof Lee Wei Ling

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Lee Wei Ling: Righting a wrong comes from the heart

Lee Wei Ling: Righting a wrong comes from the heart

January 20, 2009

Since young, I have always been upset with myself if I knew something was wrong and I could put it right but didn’t.

Hence, I often find myself on ‘quests’ or ‘missions’, ‘jousting with windmills’. Sometimes, I criticise my friends, saying, perhaps impatiently, ‘you have lost the fire in your belly’.

If there is something wrong that we know of, I believe we should try to set it right whether or not it is our business to do so. Not to do so implies we condone the wrong and hence we would be guilty of committing the wrong too.

The concept of ‘guilty by omission’ is not one that is held commonly here. But it is enshrined in the legal systems of the United States and France.

You can be sued in the US if you do not clear the ice on the sidewalks around your home and as a result, someone slips and fractures a bone. You did not cause the fracture but you would be guilty by virtue of having omitted to clear the ice.

Let me give a concrete example closer to home of the consequences of such omission: A few months ago, a colleague’s mother suffered a heart attack and was rushed by ambulance to Tan Tock Seng Hospital at night.

Horror of horrors, there was no cardiologist there. My friend desperately called one of several private cardiologists she knew personally, being a doctor herself. But what could a layman have done in similar circumstances? Nothing.

Neither Alexandra Hospital nor Tan Tock Seng outside of office hours has the resources to handle acute myocardial infarctions (AMI) or heart attacks.

Thus, they are not in a position to give patients the best chance of surviving heart attacks. Of those who survive, the chance of impaired function of the heart would be higher than for patients treated in hospitals where cardiologists and facilities were available as in the National Heart Centre (NHC) or National University Hospital (NUH).

These problems are beyond my areas of responsibility. But I am a doctor; I know what is wrong; and I know what needs to be done. I would have been guilty by omission if I had not tried to solve this problem.

So I engaged the ambulances which come under the Singapore Civil Defence Force, NHC, NUH and got them all to agree that when their ambulances pick up patients with AMI, they would bypass Alexandra and Tan Tock Seng and go only to NUH or NHC.

I do not believe homo sapiens are necessarily at the top of the evolutionary pyramid. But it is indisputable that we are different from other species in several ways.

Scientists once assured us that we were the only species that possessed language. Then research with gorillas and chimpanzees showed that they too could master sign language. Another distinguishing trait of humans was thought to be our capacity to use tools. But then we learnt otters could smash molluscs with rocks and apes could strip the leaves from twigs to use them to fish for termites.

The one feature that definitely does separate us from other animals is our highly developed sense of morality. We seem to have a primal understanding of good and evil, right and wrong, of what it means to suffer not only our own pain but also the pain of others.

Morality may be a hard concept to grasp, but we acquire it fast. A preschooler, for instance, may learn that it is not all right to eat in class because a teacher says so. If the rule is lifted, the child will happily eat in class. But if the same teacher says it is okay to push another student off a chair, the child would hesitate. He will think: ‘No, the teacher should not say that.’

In both cases, somebody would have taught the child the rules, but the rule against pushing has a stickiness about it. It resists coming unstuck even if someone in authority countenances its breach. That is the difference between a moral imperative and mere social convention. Some psychologists like Michael Schulman believe children can innately intuit the difference.

Of course, the child might on occasion hit some other child and won’t feel particularly bad about it - unless, of course, he is caught. The same is true of people who steal or despots who slaughter their people.

Marc Hauser, professor of psychology at Harvard University, has written: ‘Moral judgment is pretty consistent from person to person - that is, we all know what is right and what is wrong. Moral behaviour, however, is scattered all over the chart.’

The rules we know, even the ones we intuit, are by no means the rules we follow. There are people who have no moral instinct - psychopaths and anti-social people who commit crimes and seem incapable of being reformed. They stand out precisely because their behaviour is so bizarre.

Of the rules that we do follow, it is easier for most people to follow rules that require passively not doing anything wrong. Actively doing something right, especially if that something does not fall within our area of responsibility, is uncommon.

It is good for any country to have an active citizenry. And that is precisely why the concept of ‘guilt by omission’ should be a part of our ethos.

As Singapore climbs the economic ladder, its need for people who would feel guilty if they omitted to do something right - not merely passively do no wrong - will increase.

A rich middle-class society encircled by the material pleasures of life, happily oblivious of social inequities and the suffering of the less fortunate among us, will never become a civil or gracious society.

On the other hand, a country with little financial reserves, a middle class that is not wealthy but is socially active, that tries to lift the lowest common denominator in that society, is one that would be heading in the right direction.

Some things cannot be legislated but must come spontaneously from the heart. The desires to right wrongs and help others are examples.

Singapore is a great place for social experiments to improve both the country and the individual.

Lee Wei Ling

# The writer is director of the National Neuroscience Institute.

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Lee Wei Ling: My house is shabby, but it is comfortable

Lee Wei Ling: My house is shabby, but it is comfortable

Written by Lee Wei Ling, for the Sunday Times, 04 Jan 2009

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 an 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.

Lee Wei Ling

The writer is director of the National Neuroscience Institute.

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Lee Wei Ling: Medicine is not just a career, but a calling

Medicine is not just a career, but a calling

By Lee Wei Ling

I have always felt keenly the suffering of animals. Since I was a child, I had wanted to be a vet. My parents persuaded me to abandon that idea by using the example of a vet whose university education was funded by the Public Service Commission. When he returned to Singapore, he was posted to serve his bond at the abattoirs. That was enough to persuade me to select my second career choice - a doctor. I have never regretted that decision.

There are still many diseases for which medical science has no cure, and this is especially true of neurological diseases because nerve cells in the brain and spinal cord do not usually regenerate. Hence, a significant percentage of patients seeing neurologists, of which I am one, cannot be cured. But as in all areas of medicine, we still try our best for the patient, 'to cure, sometimes; to relieve, often; to comfort, always'.

An example is a 70-year-old woman who sees me for her epilepsy. Her husband has taken a China mistress whom he has brought back to his marital home. He wants my patient to sell her 50 per cent ownership of their HDB flat and move out. Her children side with the husband because he is the one with the money and assets to will to them.

When this patient comes, I always greet her with a big smile and compliment her on her cheongsam. She will tell me she sewed it herself, and I will praise her for her skill. Then I ask her whether she has had any seizures since the last time she saw me. She sees me at yearly intervals, and usually, she will have had none.

Next, I ask her how she is coping at home. She would say she just ignores her husband and his mistress. I would give her a thumbs-up in reply, then ask her whether she still goes to watch Chinese operas. She would say yes.

By then, I would have prepared her prescription. I hand it to her, pat her on her back and she would walk out with a smile on her face, back straight and a spring in her step.

It takes me only five minutes to do the above. I can control but not cure her epilepsy. But I have cheered her up for the day.

One very special patient, Jac, has idiopathic severe generalised torsion dystonia. By the age of 11, she was as twisted as a pretzel and barely able to speak intelligibly. She did well in the Primary School Leaving Examination, but was a few points short of the score needed for an external student to be accepted by Methodist Girls' School (MGS).

I had done fund-raising for MGS prior to this and knew the principal. I phoned her and explained Jac's disease as well as her determination and diligence.

I told the principal that the nurturing environment of MGS would be good for Jac, and that it would be a good lesson for the other students in MGS to learn to interact with a peer with disability.

At the end of Secondary 2, Jac mailed me a book and a typed letter. The book was a collection of Chinese essays by students in MGS.

There were two essays by Jac. In addition, she had topped the entire Secondary 1 and, subsequently, Secondary 2 in Chinese. She was second in the entire Secondary 2 for Chemistry. She was happy at MGS, and her peers accepted her and helped wheel her around in her wheelchair.

Medication merely gave Jac some degree of pain relief from her dystonia. Being admitted to MGS gave her the opportunity to enjoy school and thrive in it.

I was walking on clouds for the next few hours after I received the book and letter. Jac showed that an indomitable human spirit can triumph over a severe physical disability. As a doctor, I am not just handling a medical problem but the entire patient, including her education and social life.

I have been practising medicine for 30 years now. Over this period, medical science has advanced tremendously, but the values held by the medical community seem to have changed for the worse.

Yearning and working for money is more widely and openly practised; and sometimes this is perceived as acceptable behaviour, though our moral instinct tells us otherwise.

Most normal humans have a moral instinct that can clearly distinguish between right and wrong. But we are more likely to excuse our own wrongdoing if there are others who are doing the same and getting away with it.

These doctors who profit unfairly from their patients know they are doing wrong. But if A, B and C are doing wrong - and X, Y and Z too - then I need not be ashamed of doing the same. Medical students who see this behaviour being tacitly condoned will tend to lower their own moral standards. Instead of putting patients' welfare first, they will enrich themselves first.

The most important trait a doctor needs is empathy. If we can feel our patient's pain and suffering, we would certainly do our best by our patients and their welfare would override everything else.

Medicine is not just a prestigious, profitable career - it is a calling. Being a doctor will guarantee almost anyone a decent standard of living. How much money we need for a decent standard of living varies from individual to individual.

My needs are simple and I live a spartan life. I choose to practise in the public sector because I want to serve all patients without needing to consider whether they can pay my fees.

I try not to judge others who demand an expensive lifestyle and treat patients mainly as a source of income. But when the greed is too overwhelming, I cannot help but point out that such behaviour is unethical.

The biggest challenge facing medicine in Singapore today is the struggle between two incentives that drive doctors in opposite directions: the humanitarian, ethical, compassionate drive to do the best by all patients versus the cold, calculating attitude that seeks to profit from as many patients as possible. Hopefully, the first will triumph.

Doctors do have families to support. Needing and wanting money is not wrong. But doctors must never allow greed to determine their actions.

I think if a fair system of pricing medical fees - such that doctors can earn what they deserve but not profit too much from patients - can be implemented, this problem will be much reduced. The Guideline of Fees, which previously was in effect, was dropped last year. I am trying to revive it as soon as possible.

The writer is director of the National Neuroscience Institute.

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