By now, you have probably heard about my father’s red box. Minister Heng Swee Keat posted about it last week. The red box was a fixture of my father’s work routine. It is now on display at the National Museum of Singapore in his memorial exhibition.
Some of my father’s other personal items are there too. His barrister’s wig (of horsehair) from when he was admitted to the Bar. And a Rolex Oyster Perpetual watch given to him by the Singapore Union of Postal and Telecommunications Workers after he represented them in the famous postmen’s strike in 1952.
I enjoyed my visit to the exhibition a few days ago. Was happy to hear that many of you went yesterday. The exhibition will be on until 26 April. – LHL
MR LEE'S RED BOX
Mr Lee Kuan Yew had a red box. When I worked as Mr Lee’s Principal Private Secretary, or PPS, a good part of my daily life revolved around the red box. Before Mr Lee came in to work each day, the locked red box would arrive first, at about 9 am.
As far as the various officers who have worked with Mr Lee can remember, he had it for many, many years. It is a large, boxy briefcase, about fourteen centimetres wide. Red boxes came from the British government, whose Ministers used them for transporting documents between government offices. Our early Ministers had red boxes, but Mr Lee is the only one I know who used his consistently through the years. When I started working for Mr Lee in 1997, it was the first time I saw a red box in use. It is called the red box but is more a deep wine colour, like the seats in the chamber in Parliament House.
This red box held what Mr Lee was working on at any one time. Through the years, it held his papers, speech drafts, letters, readings, and a whole range of questions, reflections, and observations. For example, in the years that Mr Lee was working on his memoirs, the red box carried the multiple early drafts back and forth between his home and the office, scribbled over with his and Mrs Lee’s notes.
For a long time, other regular items in Mr Lee’s red box were the cassette tapes that held his dictated instructions and thoughts for later transcription. Some years back, he changed to using a digital recorder.
The red box carried a wide range of items. It could be communications with foreign leaders, observations about the financial crisis, instructions for the Istana grounds staff, or even questions about some trees he had seen on the expressway. Mr Lee was well-known for keeping extremely alert to everything he saw and heard around him – when he noticed something wrong, like an ailing raintree, a note in the red box would follow.
We could never anticipate what Mr Lee would raise – it could be anything that was happening in Singapore or the world. But we could be sure of this: it would always be about how events could affect Singapore and Singaporeans, and how we had to stay a step ahead. Inside the red box was always something about how we could create a better life for all.
We would get to work right away. Mr Lee’s secretaries would transcribe his dictated notes, while I followed up on instructions that required coordination across multiple government agencies. Our aim was to do as much as we could by the time Mr Lee came into the office later.
While we did this, Mr Lee would be working from home. For example, during the time that I worked with him (1997-2000), the Asian Financial Crisis ravaged many economies in our region and unleashed political changes. It was a tense period as no one could tell how events would unfold. Often, I would get a call from him to check certain facts or arrange meetings with financial experts.
In the years that I worked for him, Mr Lee’s daily breakfast was a bowl of dou hua (soft bean curd), with no syrup. It was picked up and brought home in a tiffin carrier every morning, from a food centre near Mr Lee’s home. He washed it down with room-temperature water. Mr Lee did not take coffee or tea at breakfast.
When Mr Lee came into the office, the work that had come earlier in the red box would be ready for his review, and he would have a further set of instructions for our action.
From that point on, the work day would run its normal course. Mr Lee read the documents and papers, cleared his emails, and received official calls by visitors. I was privileged to sit in for every meeting he conducted. He would later ask me what I thought of the meetings – it made me very attentive to every word that was said, and I learnt much from Mr Lee.
Evening was Mr Lee’s exercise time. Mr Lee has described his extensive and disciplined exercise regime elsewhere. It included the treadmill, rowing, swimming and walking – with his ears peeled to the evening news or his Mandarin practice tapes. He would sometimes take phone calls while exercising.
He was in his 70s then. In more recent years, being less stable on his feet, Mr Lee had a simpler exercise regime. But he continued to exercise. Since retiring from the Minister Mentor position in 2011, Mr Lee was more relaxed during his exercises. Instead of listening intently to the news or taking phone calls, he shared his personal stories and joked with his staff.
While Mr Lee exercised, those of us in the office would use that time to focus once again on the red box, to get ready all the day’s work for Mr Lee to take home with him in the evening. Based on the day’s events and instructions, I tried to get ready the materials that Mr Lee might need. It sometimes took longer than I expected, and occasionally, I had to ask the security officer to come back for the red box later.
While Mrs Lee was still alive, she used to drop by the Istana at the end of the day, in order to catch a few minutes together with Mr Lee, just to sit and look at the Istana trees that they both loved. They chatted about what many other old couples would talk about. They discussed what they should have for dinner, or how their grandchildren were doing.
Then back home went Mr Lee, Mrs Lee and the red box. After dinner, Mr and Mrs Lee liked to take a long stroll. In his days as Prime Minister, while Mrs Lee strolled, Mr Lee liked to ride a bicycle. It was, in the words of those who saw it, “one of those old man bicycles”. None of us who have worked at the Istana can remember him ever changing his bicycle. He did not use it in his later years, as he became frail, but I believe the “old man bicycle” is still around somewhere.
After his dinner and evening stroll, Mr Lee would get back to his work. That was when he opened the red box and worked his way through what we had put into it in the office.
Mr Lee’s study is converted out of his son’s old bedroom. His work table is a simple, old wooden table with a piece of clear glass placed over it. Slipped under the glass are family memorabilia, including a picture of our current PM from his National Service days. When Mrs Lee was around, she stayed up reading while Mr Lee worked. They liked to put on classical music while they stayed up.
In his days as PM, Mr Lee’s average bedtime was three-thirty in the morning. As Senior Minister and Minister Mentor, he went to sleep after two in the morning. If he had to travel for an official visit the next day, he might go to bed at one or two in the morning.
Deep into the night, while the rest of Singapore slept, it was common for Mr Lee to be in full work mode.
Before he went to bed, Mr Lee would put everything he had completed back in the red box, with clear pointers on what he wished for us to do in the office. The last thing he did each day was to place the red box outside his study room. The next morning, the duty security team picked up the red box, brought it to us waiting in the office, and a new day would begin.
Let me share two other stories involving the red box.
In 1996, Mr Lee underwent balloon angioplasty to insert a stent. It was his second heart operation in two months, after an earlier operation to widen a coronary artery did not work. After the operation, he was put in the Intensive Care Unit for observation. When he regained consciousness and could sit up in bed, he asked for his security team. The security officer hurried into the room to find out what was needed. Mr Lee asked, “Can you pass me the red box?”
Even at that point, Mr Lee’s first thought was to continue working. The security officer rushed the red box in, and Mr Lee asked to be left to his work. The nurses told the security team that other patients of his age, in Mr Lee’s condition, would just rest. Mr Lee was 72 at the time.
In 2010, Mr Lee was hospitalised again, this time for a chest infection. While he was in the hospital, Mrs Lee passed away. Mr Lee has spoken about his grief at Mrs Lee’s passing. As soon as he could, he left the hospital to attend the wake at Sri Temasek.
At the end of the night, he was under doctor’s orders to return to the hospital. But he asked his security team if they could take him to the Singapore River instead. It was late in the night, and Mr Lee was in mourning. His security team hastened to give a bereaved husband a quiet moment to himself.
As Mr Lee walked slowly along the bank of the Singapore River, the way he and Mrs Lee sometimes did when she was still alive, he paused. He beckoned a security officer over. Then he pointed out some trash floating on the river, and asked, “Can you take a photo of that? I’ll tell my PPS what to do about it tomorrow.” Photo taken, he returned to the hospital.
I was no longer Mr Lee’s PPS at the time. I had moved on to the Monetary Authority of Singapore, to continue with the work to strengthen our financial regulatory system that Mr Lee had started in the late 1990s. But I can guess that Mr Lee probably had some feedback on keeping the Singapore River clean. I can also guess that the picture and the instructions were ferried in Mr Lee’s red box the next morning to the office. Even as Mr Lee lay in the hospital. Even as Mrs Lee lay in state.
The security officers with Mr Lee were deeply touched. When I heard about these moments, I was also moved.
I have taken some time to describe Mr Lee’s red box. The reason is that, for me, it symbolises Mr Lee’s unwavering dedication to Singapore so well. The diverse contents it held tell us much about the breadth of Mr Lee’s concerns – from the very big to the very small; the daily routine of the red box tells us how Mr Lee’s life revolved around making Singapore better, in ways big and small.
By the time I served Mr Lee, he was the Senior Minister. Yet he continued to devote all his time to thinking about the future of Singapore. I could only imagine what he was like as Prime Minister. In policy and strategy terms, he was always driving himself, me, and all our colleagues to think about what each trend and development meant for Singapore, and how we should respond to it in order to secure Singapore’s wellbeing and success.
As his PPS, I saw the punishing pace of work that Mr Lee set himself. I had a boss whose every thought and every action was for Singapore.
But it takes private moments like these to bring home just how entirely Mr Lee devoted his life to Singapore.
In fact, I think the best description comes from the security officer who was with Mr Lee both of those times. He was on Mr Lee’s team for almost 30 years. He said of Mr Lee: “Mr Lee is always country, country, country. And country.”
This year, Singapore turns 50. Mr Lee would have turned 92 this September. Mr Lee entered the hospital on 5 February 2015. He continued to use his red box every day until 4 February 2015.
(Photo: MCI)
coronary stent 在 泡菜公主的粉絲塗鴉團 Facebook 八卦
很沉重的話題.....這名23歲的年輕男子因為年幼時得過川崎氏症,當時已發燒超過二個星期才被診斷出川崎症,發現時心臟已經都擴張,且無使用免疫球蛋白治療,已經嚴重影響到心臟,在青少年時期都避免他做過度激烈的運動,直到2014年心臟再度發生問題,現在這名少年已經去當天使了...這篇是那位少年的母親寫的自述告白,希望大家能多注意川崎氏症的孩子。
川崎氏症不恐怖,恐怖的是它延誤了治療所帶來的後果,不是來嚇唬大家,但我非常非常慶幸在泡菜發病前就知道名為川崎氏這病,甚至我比醫生更早發現、更早警覺,所以泡菜才能夠在治療黃金期內完全恢復。
分享給大家泡菜的發病過程
小心,發高燒的後果壞掉的可能是心臟...當父母的絕對不可不知道的疾病! 川崎氏症
http://bluerin0726.pixnet.net/blog/post/104754286…
KD in Adulthood
My son contracted KD in 1991 when he was just over a month old. I remembered him having to endure the fever for 2 weeks and not one GP could tell us what was wrong. In the end, we brought him to Thomson Medical where after a battery of tests, the attending pediatrician Dr. Ang Ai Tin diagnosed him to have KD. At that time, there was no such thing as IVIG hence my son actually went through the whole inflammation process without medication.
As a result, both his coronary arteries were dilated with the right one being worse than his left.
We were referred to Dr. William Yip for further heart assessment/scans and were on follow up weekly for a month, then every 2 weeks for a while and finally, once a month for 6 months. His left artery aneurysm resolved when he was a toddler. My son had been on aspirin since discharged from Thomson in 1991 till his passing in July last year.
During his teens, he was active in his football and NCC despite being told by the cardiac doc to keep off strenuous sports. Let’s just say all was well during his school years. He had his annual cardiac scan and by his late primary years, the right artery had gone back to almost normal. Annually he was still having his heart scan. In his late teens, he underwent a treadmill stress test, an angiogram and a MIBI (myocardial perfusion test) on separate occasions. The results were good and showed that his arteries were patent and his heart was good.
As he was given the all clear that he was doing ok, I guess we got complacent. After his last heart scan in 2010, my son defaulted the subsequent annual check ups. I was not staying with my son hence my verbal reminders for him to go for his check ups went into deaf ears.
Feb 2014, my son had his first heart attack. He felt chest pains and was unable to breathe well and was admitted to TTSH A&E. He was found to have a heart attack and given strong anti-coagulants to unblock the artery. The cardiac consultant told us that his right artery had a HUGE aneurysm and my son was “lucky” that only a clot was formed. Had the aneurysm burst, it would have been a sudden death. He then discussed with us the option of either a stent to “close up” the aneurysm and keep the artery patent OR a coronary artery bypass graft (CABG) to bypass the aneurysm. The former would be a keyhole surgery whereas the latter would be an open-heart surgery. He also said he would consult his fellow cardiac colleagues as to which treatment is better as both carried its own risk.
After much discussion, a stent was the chosen treatment as it’s less risky and its prognosis was good with proper after care. The after care included minimal strenuous activity for 3 to 6 months and he had to be on very strong anti coagulants for a year. After which the medication will be reviewed.
The stent operation went well and my son responded to the stent well. He was back to his usual lifestyle and all appeared well. He was very diligent in his medication and we even went for our last holiday together 4 weeks post surgery.
In July 2014, he had some bleeding from the rectum for a few days. He endured the bleeding not wanting to worry us but subsequently told us, as he was feeling very weak. His face was very very white according to my ex-husband and he was immediately rushed to TTSH A&E. He was found to have internal hemorrhage and was transfused with 3 bags of blood. His hemoglobin level was 4 (normal is about 12).
Meanwhile, all his anticoagulants were stopped as the doctors suspected it was the cause of his internal bleeding. On Sunday (13th July) after he was transfused with the blood, his bleeding stopped.
He had a nasal endoscopy done on Monday to determine the cause of bleeding but nothing was found. On Wednesday, they did another endoscopy from the rectal end and again nothing was found. Meanwhile he had already stopped his anti coagulants for 4 days.
On Wednesday night, my son suffered another heart attack. He was being resuscitated for almost 2 hours but they just could not jump-start his heart. Towards the last part, they managed to run a catheter through his right coronary artery to break up the clot but it was too late. The heart just never beat again.
I feel very strongly about getting the heart checked even though an all clear is given. As we don’t have x-ray vision, we can never ever tell when the arteries might act up again hence it is important never to be complacent.
~~~ Magdalene
coronary stent 在 Dr. 林葳牙科診療室 Facebook 八卦
💉服用通血路藥物的病人, 牙科手術前需不需停藥? 💉
☝️首先,我們要了解什麼是通血路藥物。
血液的凝固,需要靠凝血因子與血小板的作用。依照不同的作用原理,可以分為抗血小板藥物與抗凝血劑。
💊抗血小板藥物
作用原理:抑制血小板
常見藥物:阿斯匹靈/伯基(Bokey/Aspirin)、保栓通(Plavix/Clopidogrel)、百無凝(Brilinta/Ticagrelor)…等。
適應症:缺血性腦中風、心肌梗塞…等
💊抗凝血劑
作用原理:抑制凝血因子
常見藥物:可邁丁錠(Coumadin/Warfarin)、普栓達(Pradax/Dabigatran)、拜瑞妥(Xarelto/Rivaroxaban)、艾必克凝(Eliquis/Apixaban)…等。
適應症:靜脈栓塞、心房顫動血栓型中風…等
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✌️牙科手術前需不需要停藥?
過去普遍認為,服用通血路藥物者,狀況允許下最好先停藥一段時間,等凝血功能較為正常,再做牙科手術(Aspirin停7天,wafarin停5天)。但這幾年似乎有越來越多的研究認為不一定要停藥-理由是未停藥的流血風險可能被高估,而停藥的心血管風險則被低估。貿然停藥可能會導致心血管併發症的風險。
💊抗血小板藥物
不停藥:增加的流血風險應該不高,且多半無生命危險。
停藥:增加的血栓風險也應該不高,但有可能致命。
Michael J. Wahl 2014年的文獻回顧,1,282位未停藥的牙科手術患者,只有2.7%需要術後局部止血,較嚴重而無法以局部方式止血者可能只有0.2%[1]。Kovacic 2012年的研究,任何理由停藥造成的血栓機率大約1% [2]。Biondi-Zoccai 2006年的統合分析(meta- analysis),停藥造成的嚴重心血管病變風險可能增加3.14倍(註1),若是裝心臟支架的病人停藥風險則會明顯更高)(註2)[3]。S. Nathwani 2016年在英國牙醫學會的期刊(British Dental Journal)撰文建議,服用抗小板藥物者雖然牙科術後出血風險增加,但多半可經由局部處理安全地止血而不需停藥[4]。
💊抗凝血藥物
停藥造成的栓塞,致命性可能高過未停藥造成的流血,雖然機率都相當低。
Michael J. Wahl 2015年的文獻回顧,5,431位未停藥的患者中,有0.6%無法以簡單的局部方式止血,當中沒有人因失血而死亡;而在2,673位停藥或減量的患者,出現栓塞併發症(embolic complications)的機率0.8%,其中危及性命(fatal event)的機率則為0.2%[5]。2015年的另一篇文獻回顧指出,服用wafarin者若INR在therapeutic range內,牙科手術前應該可以不用停藥[6]。Mariele認為INR = 2.5的狀態最適合牙科手術,Al-Mubarak表示INR < 3,拔牙前不停藥還算安全[7]。INR > 3.0則要小心,不要貿然做侵入性治療。
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👌結論
受限於研究方式以及病人個體的差異,停藥增加的心血管風險、以及不停藥引發的流血風險,難以確切計算機率。然而對於一般的牙科門診手術,多半可以局部方式達到止血。紗布加壓、傷口縫合、止血棉甚至膠原蛋白,都是常見有效的局部止血方式。
由於醫療存在高度差異且需要高度分工、再加上藥物的推陳出新,停藥與否有賴病人、內科醫師、牙科醫師(甚至口腔外科醫師)充分評估與討論。各位病友千萬別未經醫師許可就擅自停藥!
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註1. OR = 3.14 [1.75–5.61], P = 0.0001。嚴格來說odds ratio不能當成是機率, 但為了方便一般民眾理解,故以此解釋。
註2. OR = 89.78 [29.90–269.60]
參考資料:
1. Wahl, M.J., Dental surgery and antiplatelet agents: bleed or die. Am J Med, 2014. 127(4): p. 260-7.
2. Kovacic, J.C., et al., Safety of temporary and permanent suspension of antiplatelet therapy after drug eluting stent implantation in contemporary "real-world" practice. J Interv Cardiol, 2012. 25(5): p. 482-92.
3. Biondi-Zoccai, G.G., et al., A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J, 2006. 27(22): p. 2667-74.
4. Nathwani, S. and K. Martin, Exodontia in dual antiplatelet therapy: the evidence. Br Dent J, 2016. 220(5): p. 235-8.
5. Wahl, M.J., et al., Dental surgery in anticoagulated patients--stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015. 119(2): p. 136-57.
6. Management of Dental Extractions in Patients taking Warfarin as Anticoagulant Treatment A Systematic Review.
7. Al-Mubarak, S., et al., Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J, 2007. 203(7): p. E15; discussion 410-1.
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