Double Happiness

Yipee…we have finally heard from our obsterician Dr Tham. The long and short of it is that there is a small risk of having spouse in the operating theatre but as long as we agree to cooperate at all times, he will allow Tim to be present during the delivery. We just LOVED how he manages to explain the above in standard “anything-go-wrong-you-can’t-blame-me” medical lingo… But I can understand how surgeons really need to protect themselves from any lawsuits, since my ole friend Dr Ziyun has kindly explained to me before. Below is his exact advice:

“There are however disadvantages with the spouse in the OT because of possible increase risk of infection, distraction of the surgeon’s and nurses’ attention and occasional interference of the processes by an anxious spouse during the delivery process. The outcome may be compromised as a result. For those reasons, we usually advise against spouse accompaniment because we want to ensure optimal outcome for the mother and baby.

But as long as you understand the limitations and possible sub-optimal outcome of the delivery process, and that Tim should cooperate and comply strictly with my advice at all times, I will consent Tim to be with you during the surgery. If we can have an agreement on this, having Tim by your side would certainly be great. Please understand that should Tim be asked to leave the theatre at any time during the surgery, it is usually for a good reason, and it would be best for the interest of the mother and baby that he does so.“

With that settled, we will probably sign up for the Premiere Package B1. B1 means 4 patients to a room, with the babies’ charges such as nursery charges, medication and vaccination pegged to B1 rates. At first we were considering splurging on A1 package (where we have the whole room to ourselves, Tim can stay overnight with me and babies can room in) but decided that there is a risk that the babies may need some special care or extra medication (touch wood!!) and we had better play it safe. Even if all goes smoothly, A1 is still more expensive than B1 by at least $1,500 which is not payable by MediSave. I guess we can do other things with the money… Like contribute that to our buy-a-car fund…

We just had our latest check-up at KKH on Monday. The detailed scan showed that the baby boy is 2.24kg and baby girl is 2.15kg, both good weights at 33 weeks. Tim and I are both very pleased to pass that 2kg threshold (NICU is definitely required for newborns below 2kg). Dr Tham was very happy as well and assured us that post 34 weeks, the need for NICU is very low, especially since the babies are of a good weight. However as both babies are still in breech position, it is very likely that a c-section would be required. Dr Tham suggested that we can choose a day for elective c-section around 20 April (37th week). A quick check at the Chinese calendar by my mum shows that 21 April is an auspicious day, otherwise 18 April is acceptable as well.

After the check-up, we went around to check for details on KKH’s delivery packages. Instead of going to a private hospital, perhaps we can opt for the Premiere Package which Dr Tham mentioned a few months back that would allow Tim to be present during the c-section operation. A check at the counter at The Private Suite revealed that once we sign up for the Premiere Package, it is NOT AUTOMATIC that fathers will be allowed in the operating theatre. What it does is that it allows the chosen obstetrician the right to grant permission for fathers to be present. Given that Dr Tham does not seem convinced for the need of the father to be present, we decided to play it safe and pop him an email to confirm whether he would grant Tim the permission. Only if he says yes would we sign up for the Premiere Package. We are now waiting for his reply…

Meanwhile there are still a few things to be done between now and when babies arrive – 1) pack my ‘hospital bag” to bring with me to KKH on day of delivery; 2) set up the nursery to ensure space for babies’ clothes and maid’s clothes; 3) test how the sterilizer and breastpump work; 4) purchase of the last few items we have missed out (eg: baby bath tub). I intend to take it slow and try to do one thing at a time, maybe one task a day.

It’s been more than a week since I’m home from KK Hospital. Already the whole experience of staying in hospital seems quite remote. As I lie on my bed, perspiring despite having the aircon blasting at 22 degree Celcius, I wonder how on earth I had made it through the stay without aircon. I really really hope that I shall never need to return to Class C again.

The plan is this – if the babies are good and arrive at week 34 or later (deadline: 1 April – easy enough to remember!), we will opt for Class B2+. It’s the cheapest ward possible that provides aircon!!! It’s certainly still a subsidized class (ie: only Sporeans can opt for this class) but there’s still quite a bit of difference from class C charges:

• Price of mother’s ward is $115 daily (compared to $25 for Class C)
• Price of Babies’ Intensive Care (NICU) is $480 daily for two (compared to $200 for Class C). With special medication it may come up to twice the amount
• Price of Babies’ Special Care is $250 daily for two (compared to $100 for Class C)
• Price of Babies’ Nursery Care is $100 daily for two (same as Class C)
• Cost of C-section operation is around $1500

From my calcuation, assuming babies born at week 34 have to stay in NICU for 2 weeks, the total cost would be around $10,000. A large chunk of this can come from Tim and my Medisave.

As the babies (at week 32) are now still in breech position, it is likely that delivery would be by C-section. Under KKH’s regulation, fathers are not allowed in the operating theatre during C-section. Ziyun suggested that since our rapport with Dr Tham is not all that cosy, we may want to consider going to another obstetrician and delivering in a private hospital which allows fathers to be present. Of course this is provided that the babies arrive at week 36 or later (13 April) as private hospital’s NICU charges are much higher. Have decided to try out Mt Alvernia as it is one of the cheapest private hospital and it allows fathers to be in the operating theatre if the doctor is fine with that.

• Cost of C-section delivery by private obsterician is about $2,000 (depending on doc)
• Hospital charges for C-section operation with epidural and 3-day stay in a 4-bedder ward is about $1,800 (including standard medication and procedures)
• Price of Babies’ Intensive Care (NICU) range from $180 to $920 daily for two, depending on intensity of care. With special medication it may come up to twice the amount ($2,000 daily for two, gasp!!)
• Price of Babies’ Nursery Level 1 is $180 daily for two
• Price of Babies’ Nursery is $95 daily for two

We intend to go for a consultation with an obsterician who practises at Mt Alvernia once the 33-week growth scan at KKH is over on 26 March. That way we can have the latest position and estimated weight of babies for the obsterician to make a better judgement of whether they would require NICU and whether he/she would allow Tim to be present in the operating theatre. Will look through reviews online at TwinsPlus.com and SingaporeMotherhood.com for feedback on good obstericians. Really hope that the babies are at a good 2kg for the next scan! Will keep everyone updated.

It is with great pleasure that I announce to everyone that the doctors at KK Hospital have decided to discharge me yesterday, ending my 18-day stay at the hospital. The decision was made based on 4 factors – 1) my cervical length has not shortened, showing that continued bedrest may be sufficient to prolong pregnanacy; 2) babies are at 31 weeks which, while still far from the ideal 34 weeks, is still viable; 3) 18-days of careful monitoring shows my condition is quite stable (in terms of uterine contractions, babies’ heartbeats, my blood pressure and temperature); 4) my commitment to be disciplined and continue the same horizontal bedrest at home.

I gave Tim a call and he came down at 1pm to fetch me and my tons of worldly possessions home. I said bye to the nurses, many of whom have been very patient and kind to me. I managed to write a long feedback form to the KKH management, applauding some of the doctors (Dr Taufik, Jazlan and Kenneth Kwek), nurses (esp Nurse Manager Poh whom I have a deep respect for as she is so devoted to her work), caterer and cleaning personnels.

At the same time I also gave my honest feedback on two areas they can do better – 1) the food (oily breakfast, Kellog flavour soup, jelly and cakes instead of fruits) and 2) attitude of a few of the doctors – without giving names of course (not taking time to listen to patient queries, more interested in finishing rounds, brushing aside concerns, insensitive choice of words). Now that I think back… perhaps I should not have said so much because one of these doctors may be operating on me… Sheeeesh… sometimes one does something silly only to regret it later. However, I vouch by my comments – they are my honest observations, not born out of vengence or high-handedness.

The first day back home was like a dream. I get to caress my cats, lie on our king-size bed in absolute aircon bliss, sit on the sofa (with my legs propped up horizontally, of cos), shower in the familiar bathroom without the stale smells, make phone calls from our landline without worrying about the high outgoing-call costs of mobile phones and bad connection, play music without worrying about disturbing others, and watch TV on a giant LCD screen instead of the 9cm x 5.5cm Cowon (which has served my very well, but still!). These are all things that one tends to take for granted, it is only when you are deprieved of them do you realise how blessed we are to be surrounded by these daily conveniences.

Our next major task is to engage a domestic help, one who can start work on 1 April. Today I flipped through the papers and made a few phonecalls, then Tim did the legwork to go down to the agencies and collect the biodata of suitable candidates. Now that I’m bedridden, there is limited help I can give to all the tasks that still need to be done to prepare for the arrival of the babies. Tim’s tasklist has lengthened correspondingly as a result, my poor husband… Perhaps this may help him to unconsiously lose a few pounds =)

Today the babies are 30 weeks + 2 days and a growth scan shows that ah-boy is 1.7kg and ah-girl is 1.66kg. It is not a bad weight but we’re a bit disappointed that they have grown only 200g in the last 2 weeks. We were hoping that with Tim’s genes the babies would be closer to 2kg by now. On the other hand, my cervical length is 1.4cm today, slightly better than the 1.1cm last week though still far from the 2.5cm safe range. Still, if my condition remains stable, Dr Kenneth Qwek, head of the High Risk Consult, may allow me to go home for bedrest at 32 weeks, which is around 17 March. He wouldn’t recommend any earlier and if I insist on leaving, I would have to sign a ‘discharged against medical advice’. Being my kiasu self, I of cos would not do that.

By now I am quite used to the hospital routine, a typical day goes:

7.30am: House Office (HO) and Medical Officer (MO) make their rounds, asking routine questions like ‘Any pain’, ‘Any contraction’, ‘Any discharge’? This is the time to give my queries to the doctors as they will not be around until same time next morning

7.45am: Nurse will dispense 2 adalat and 1 iron supplement for me to take after breakfast with the rest of my supplements.

8am: Breakfast is served. Usually there’s congee, rice or even fried noodles. A cup of Milo is always included. If the breakfast looks too oily for me (eg fried kway teow), I can ask for 2 slices of bread with margarine and jam. I miss my usual cereals and toast. If the High Risk Consult team drops by, it’s usually around 8~8.30am. This is the time I ask Dr Kenneth Kwek all my burning questions.

9am: CTG time. Senior nurse will strap me with 3 monitoring devices to the CTG machine which provides traces of each fetal heartbeat and maternal contraction. I have to lie as flat as possible (without becoming too breatheless) and remain as still as possible for the entire tracing. Sometimes babies are good and it takes 45mins. Sometimes babies are too active and I have to be strapped down for almost 2 hours. Ah-boy is so far more obedient, can always be found at the same spot, is happy to lie still and hence providing a beautiful continuous trace. Ah-girl seems more active and plays hide-and-seek, she moves around too much and sometimes her trace disappears altogether and we have to start all over again. Also, ah-girl’s heartbeat is constantly higher than ah-boy’s. This could be an indication of their personalities, we shall see!

10am: Warm barley drink is served.

10am-12noon: This is when I use the laptop to surf the net or write emails.

12noon: Lunch is served. It’s usually a soup, one dish of meat, one dish of vegetable, one HUGE serving of rice and one dessert (usually aga-aga or fruit compote). I have tried one week of Chinese food and it is quite bland, especially the vegetable which swims around in a pool of water. The meat is always either chicken or pork. Ths soup is worse, flavoured with Kellog’s chicken cube and a few morsels of vegatables. I then tried one week of muslim meal which was exciting at first because of the beef and mutton and the spices. But after a few days of 3 spicy meals a day, I noticed the blend of spices seem to be the same, the only thing that changes is the meat. It gets nauseating after a while and I have to get Tim to buy me something different like Deli France tuna or egg sandwich. Fortunately Tim is not a fussy eater and doesn’t mind eating my hospital meal while I feast on something more interesting.

12.30pm: Tim pops by for lunch visit and stays for about an hour.

2pm-5pm: This is what I call the sauna period. It is the hottest period of the day where every contact with the mattress means heat and sweat accumulation. I try to lie on one side to minimize my skin contact with the mattress, and turn every 30 mins or so to a new position on the bed where heat has not penerated yet. This is the most UNBEARABLE period of the day. I try to either sleep, read or watch something on the Cowon. Not a good time to use the lapton because it requires me to sit upright, with maximum contact with the mattress.

2pm: Nurse will dispense 2 adalat

3pm: A cake or pastry is served together with either Milo or milk, I usually ask for milk as it’s less sweet and less heaty.

5pm: Dinner is served. Menu is the same as lunch except that instead of a dessert, a fruit is served. I am usually not in the mood for dinner at all at 5pm, since in my ex-life outside the ward I usually only eat dinner at 8 or 9pm! But stone cold hospital food tastes even worse, so I psycho myself to begin eating latest by 5.45pm.

5.15pm: I go for my daily shower. This is one of the highlights of the day. I wish I can take more than 1 shower a day but decided not to take the risk – the floor being slippery and too much out-of-bed time.

6.30pm: If my parents visit, this is the time they pop by as they try to catch the last shuttle bus from Bugis MRT to KKH.

7.30pm: Tim usually arrives at this time and stays up to 2 hours. We catch up on the happenings of the day, brainstorm for baby names, and he gives me a back rub. He leaves around 9pm to work some more at home.

8pm: Nurse will dispense 2 adalat

9pm to 11.30pm: I read or watch something on the Cowon. This time of the day is more pleasant and I perspire less. After midnight is the best as the temperature is the lowest.

2am: Nurse wakes me up to dispense 2 adalat

5.30am: Nurse wakes me up to tke blood pressure and temperature. Sometimes I am unable to sleep after that.

And the day goes on…two more weeks of this, I shall be bored out of my skull…

Today is my 12th day being warded in KK Hospital. Seeing that Tim has done a very good job summarizing my plight, I wasn’t very motivated to write, especially since it is quite impossible to find a good position in bed which allows me to type properly and at the same time not put too much pressure on my lower belly. Still, I think the overseas folks (namely Evelyne, Jean, Huijun and Ziyun) would like an update, even if just to know I haven’t popped yet~!

My current home in Ward 34 bed 2 is a 6-bedder, non-air-conditioned, class C ward, with maximum noise and minimum personal space – it also happens to be the very cheapest with 80% subsidy from the government. It makes the most financial sense to be warded here since infant charges is pegged to class of mummy and NICU is extremely expensive ($120 per day per baby is the subsidized C Class rate!) and would be a high cost to bear if the babies make an early appearance. “Bare minimum” is the best descriptor for this little corner of mine but with Tim consistently bringing me stuff from home for my daily needs, this corner is quite self sufficient. I am surrounded by a host of personal items that signify to all nurses, cleaners and other patients that I’m a long-term resident here. I have my own pillows and bolster, 3 pots of flowers, a fruit basket, snacks (currently it’s pineapple tarts and cashew nuts), a big bag of toileteries, several books, my laptop, Tim’s Cowon and 3 chargers.

To be honest, the stay here is quite a break from the usual hustle and bustle of working life, and probably better for the development of the babies both phyically (since I’m lying down all the time) and psychologically (since I’m not all stressed up with work). I can bear with the lousy food, the boredom, the stale-smelling washroom, the constant chatter of my ward-mates, the disturbed sleep when babies cry and nurses wake you up at 2am and 5.30am. It is only the heat and humidity that gets to me. To be covered with a sheen of perspiration down the back and between every fold of the skin is a sensation I didn’t have to put up with since student days where classrooms are not equipped with air-conditioner. I have developed heat rash on my neck. Air conditioning has become part of the basic creature comfort for me. Besides that, I miss the comfort of home and my three cats. The growing belly makes me breatheless in certain positions and the stronger baby kicks near my cervix area make me squirm in pain, and is enough to wake me up at night.

Patients staying in Class C are very different from the people I generally come into contact with. There is an Indian girl aged 32 who just gave birth to her 7th child. She doesn’t work and her husband takes home around $1500 a month… all that to feed a family of 9?! There was a pretty 19-year-old Chinese girl who gave birth just 3 days ago. I noticed that her parents did not visit her and that her visitors are mainly young, angry-looking teenage girls with mini skirts and tons of makeup. She later told me that her father did not visit often cos her stepmother did not like her… and her own mother died when she was 12. She has finished her O-levels and hopes to go back to school one day but now with the baby it may take a few more years. A Malay woman who was warded at 35 weeks and is still here now was telling me that her pregnancies are usually problematic and result in hospital stays so she has phobia of getting pregnant again. Since this is her third pregnancy, I asked her why doesn’t she consider tying the tubes. Her only reason? In case she gets divorced, she wants to be able to give birth for her next husband.

These are perhaps the people who have fallen through the cracks of the affluent Singaporean society – the financially poor, the broken family and the lowly edcuated. What kind of children will they bring up? Is it going to be a vicious cycle? It seems that it is those who have the financial means and intellectual ability to raise kids who are unwilling to give birth while those who can ill afford it choose have more kids than they can afford. Perhaps that’s the way the human race ensures that society will always have a broad base of people at the bottom of the hierarchy.

On my own front, my parents visit me very often, at least once in 2 days, bringing wih them a healthy meal, fruits, snacks and fresh water. As they stay quite far away and there is no direct bus from their home to here, I really appreciate their efforts. Such is parenthood, I suppose. It is continuously giving. A wise Chinese teacher once told us: there is no way children can ever return their parents the same amount of love, the only thing one can do is to be to be loving parents themselves and so pass it forward.

Tim has been a very supportive husband, coming to visit me during lunch and after work. These are usually the highlights of my day cos he’s around to make me laugh and give me a comforting back rub. I have come to realise the value of laughter to a person’s overall wellbeing – it is so important to be in good humour and a few hearty laughs feels really good. I guess that’s where I got it good – I have married a funny man, the angmoh version of Stephan Chow. I have also married a kind man, one who gives back rubs even when he is dead tired at the end of a workday. At the risk of sounding really mushy, this stay in hospital has its own silver-lining, the greatest of which is the realisation that I am truly lucky to have married a man like Tim.