Don't fear the end
When a rich magnate like the Tangs scion Tang Wee Sung gets hauled up for organ trading investigations, it made me realise a few things:
1) No matter how rich you are, you will die someday. Death is truly the great equaliser.
2) Some things, money just can't buy - that includes love and kidneys.
3) Despite that, people will go to great, even illegal, lengths to prolong their lives.
So on the third point, I wonder: why?
Do they fear the unknown of death? What lies on the other side of eternal unconsciousness? Depends on your religion and philosophy, you could be in heaven, or hell, or languish in purgatory. Or be reincarnated. Or lie in nothingness - limbo. Why do people want to live on? For their families? For themselves? Are there so many important things to do in life that we panic when the time's up button lights up? What do they not want to give up?
I've thought about this a great deal. What I would like to be done when I am dead, after I am gone. My will is written. All that remains is to think about what to do when it is clear that I am going to die. I am talking about the AMD - Advanced Medical Directive.
My mother signed the AMD on Saturday morning. She is a devout Catholic and had put off signing this for as long as possible until she had as much information as she could get. She talked to us, prayed about it, talked to a priest. And on Saturday, she decided. Her sister is her witness, together with her GP. In the car, she casually told us: "Eh, I'm signing the AMD today. So you all know ah."
Ever-curious, Gillian asked: What is this?
We explained briefly and she erupted in horror. "WHAT?? Don't save Mama? What kind of daughter are you?" she shrieked at me in the car.
It was hard to summarise the debate that surrounds the AMD in five minutes so we left it for now but I have mental note to talk to the children about this.
For I too, have decided to sign an AMD. Even beyond an AMD, I do not plan on seeking active cures/treatment if ever I am diagnosed with a terminal condition. For example, as I told KH recently, if my kidneys ever failed, I don't think I want to seek dialysis.
What kind of life would that be? If I had chronic kidney disease or cancer, I think I would be in pain all the time, weak, unable to travel, unable to eat what I liked. I have a deep fear of needles and dialysis involves needles. Lots of them. Big ones too. What quality of life is that? For me, getting a diagnosis of a failing kidney just tells me that I have enjoyed life to the fullest already, and the end is near, so better get my house in order, say all I have ever wanted to say, write all I want to write and get ready to go.
It's not that I do not treasure life. I think I treasure it too much to live it as a shadow of what I used to live. I may not be a millionaire or world leader with so much to give up and so much to lose, whose death will make a big impact on society. But even as an ordinary Jane with my own simple pleasures, anything that takes even those simple easy pleasures away makes it a life not quite worth living.
Nor would I fight so hard to consider alternatives - eg going overseas to get an organ transplant, seeking radical experimental expensive treatment, going for chemo etc. That would be debilitating on the finances, a burden to the children (even if this were a burden they would gladly bear), possibly an increase in pain and suffering, definitely a decrease in life quality - and for what? Prolonging the inevitable for a few more years?
No, I know that life is finite. It all has to end someday. It's just time to go. I don't think I am afraid to die. I would feel sad to go and to leave my children though. But because of my faith as a Catholic, I believe it is not the end, just a beginning of something more. As a Catholic, I know I would see them again someday. I can think about even seeing them from wherever I am - on one of Cait's fluffy bunny-tail clouds that she is forever drawing. And if I was a good girl in life, I'd even get to see God!
So no, I'm not afraid of dying.
I would seek out palliative care to make sure I was comfortable and as painless as can be, but I would not seek treatment aggressively.
I don't think its macabre to think about all this now even when I am 'hale n hearty'. Its always good to get this sort of stuff into the right perspective before you are blindsided by it.
And I think it's good to research and plan your own funeral. It would not matter to you anymore, (though actually the thought of lying in state in one of those big tacky gilt-edged mahogany numbers really scares me!) but it would to your family members. And when you come from a big family its sometimes best to just get your preference known.
For example, ever considered an eco-burial? I mean, we already leave gigantic carbon footprints in life, how about minimising it in death? So I am considering 'greener' practices like not embalming (which means no wake - not a bad thing, saves money and kachang) and maybe use a simple chipboard casket? Or just a shroud? Okay, okay, my sarcastic brain is taunting me with thoughts of sky burials instead where buzzards pick me off bit by bit. So maybe thats a bit of a stretch...
But certainly an eco-burial/cremation is looking very attractive. And wouldn't it be nice to have an eco-cemetery where one is buried in a landscape with no headstones, using only plants and trees to mark the spot, such as the lovely grounds of Honey Creek Woodlands at a Trappist Monastery? But okay, in land-scarce Singapore, you'd be dug up in 30 years. Which brings me to my brilliant plan of being cremated and stuffing my ashes under some plant so I could go live with Owain. Okay, I can see how his wife might object someday, but haha, this is the best way to annoy a DIL! 'Course, she could always not water the plant and let it die... Or maybe instead of annoying the DIL, I could be scattered in the places I love? A bit in Venice, a bit in the Mediterranean, a bit of me in the Alps, a bit of me in Japan, a bit in Malacca, a teensy bit in the waters off Hawaii and so on.
But if my kids are anything like me, who can keep a placenta in the freezer for more than 2 years and not do a thing, I'd probably end up half-forgotten, perched on someone's bookshelf, for years... Which is also not a bad thing...
Monday, June 30, 2008
My Love-Hate Relationship with Chinese
Yesterday's Sunday Times featured an American billionaire who moved to Singapore just so he could give his daughter a 'Chinese-oriented' education. This guy, who can probably buy up all the schools in Singapore, is resorting to doing volunteer work at a school to chalk up the 40hours needed for him to qualify registering his daughter in an earlier phase instead of the usual Phase 3 for foreigners (by which time all places in good schools would have been snapped up).
They have a live-in nanny who speaks Mandarin to the girls, plays Chinese songs etc. The child, apparently can speak flawless Mandarin. Lovely.
I posted in AP that this man puts parents like me to shame. Here I am, praying and trying every means possible to get my kid out of Chinese for good and here he is, moving halfway across the world just so his kid could grow up immersed in Chinese! And for good measure, this man is American and I am Chinese! I think his household is probably more Chinese than mine!
But here's the difference between me and him.
He loves the language and the culture, he sees value in it, and if his kid does not do well in PSLE he has the moolah to hire an army of tutors or just pack up and go to a less punishing system. He's not doing the Chinese thing just so his kid could pass an exam and go to a good school. He is doing it because he genuinely sees value in learning the language. He's coming from a totally different perspective.
We, on the other hand, learn Chinese because we are forced to. We're stuck. We need to learn and pass the language (preferably with flying colours!) just so we can move up a notch in the education ladder. We don't see the value. Yes, we know China IS going to be the next big thing. I totally agree with the billionaire on this. But that does not drive us.
So what drives us? The near-sighted practical stuff. Like passing exams. Getting my kid into a decent school. Who cares about whether China is the next big economic superpower to dwarf the rest of the world? We study Chinese because we have to, not because we want to. And in the ever-growing numbers of households like mine, who are none-Mandarin speaking, the thrust into the must for Chinese is a big culture shock and stress point.
In all honesty, although my DNA says I am Chinese, culturally, I am peranakan and have grown up with Baba Malay being spoken all around me. I am more comfortable with Malay than with Chinese. So I think my 'mother tongue' is more Malay and Hokkien and not Chinese. In fact some have countered that Mandarin is an unnatural mother tongue for most of us, since more of us grew up speaking dialects (which is all but lost now). Even for KH, who grew up in a more 'Chinese' family than mine, speaking a combination of Cantonese and Mandarin, his Mandarin is worse than mine!
I would rather have been given the choice to do an Asian language - maybe Malay or Japanese, but not forced into Chinese just because my skin says I am Chinese. It was painful for me and my parents back then.
I see the same pain with my kids today - even as I work to lessen the stress with the Kumon classes, the Berries, all the enrichment classes in school, the CD-ROMs we buy, the Chinese books we read etc. Still painful. Some things never change.
Note though that I don't think Chinese is uncool in any way. I like the language - now. But not then. We are all different in how, why and when we warm up to the language. For me, I find a greater interest in Chinese now than I ever had in school. I actually derive pleasure in ploughing through a Chinese book, armed with a dictionary which I would painstakingly comb to understand the word/meaning etc. I find a great deal of elegance, beauty and poetry in the lyricism of its phrases, some phrases even the English language would find hard to convey in similar style!
However, as a parent, I wish the system would (1) allow our kids choice to choose an Asian language (Mandarin, Malay, Japanese, Hindi, Tamil), not just plonk us according to race and (2) make learning this fun and engaging and (3) if examinable, would not lump lang grades with English, Math and Sci in the final PSLE scores. IMO, it might be a better indication of academic ability if one took MT out of it. Finally, (4) not link MT grades with entry into institutions of higher learning.
The billionaire got it right - successful language acquisition stems largely from enthusiasm.
But of course, having the moolah to have live-in nannies from China never hurt too!
Yesterday's Sunday Times featured an American billionaire who moved to Singapore just so he could give his daughter a 'Chinese-oriented' education. This guy, who can probably buy up all the schools in Singapore, is resorting to doing volunteer work at a school to chalk up the 40hours needed for him to qualify registering his daughter in an earlier phase instead of the usual Phase 3 for foreigners (by which time all places in good schools would have been snapped up).
They have a live-in nanny who speaks Mandarin to the girls, plays Chinese songs etc. The child, apparently can speak flawless Mandarin. Lovely.
I posted in AP that this man puts parents like me to shame. Here I am, praying and trying every means possible to get my kid out of Chinese for good and here he is, moving halfway across the world just so his kid could grow up immersed in Chinese! And for good measure, this man is American and I am Chinese! I think his household is probably more Chinese than mine!
But here's the difference between me and him.
He loves the language and the culture, he sees value in it, and if his kid does not do well in PSLE he has the moolah to hire an army of tutors or just pack up and go to a less punishing system. He's not doing the Chinese thing just so his kid could pass an exam and go to a good school. He is doing it because he genuinely sees value in learning the language. He's coming from a totally different perspective.
We, on the other hand, learn Chinese because we are forced to. We're stuck. We need to learn and pass the language (preferably with flying colours!) just so we can move up a notch in the education ladder. We don't see the value. Yes, we know China IS going to be the next big thing. I totally agree with the billionaire on this. But that does not drive us.
So what drives us? The near-sighted practical stuff. Like passing exams. Getting my kid into a decent school. Who cares about whether China is the next big economic superpower to dwarf the rest of the world? We study Chinese because we have to, not because we want to. And in the ever-growing numbers of households like mine, who are none-Mandarin speaking, the thrust into the must for Chinese is a big culture shock and stress point.
In all honesty, although my DNA says I am Chinese, culturally, I am peranakan and have grown up with Baba Malay being spoken all around me. I am more comfortable with Malay than with Chinese. So I think my 'mother tongue' is more Malay and Hokkien and not Chinese. In fact some have countered that Mandarin is an unnatural mother tongue for most of us, since more of us grew up speaking dialects (which is all but lost now). Even for KH, who grew up in a more 'Chinese' family than mine, speaking a combination of Cantonese and Mandarin, his Mandarin is worse than mine!
I would rather have been given the choice to do an Asian language - maybe Malay or Japanese, but not forced into Chinese just because my skin says I am Chinese. It was painful for me and my parents back then.
I see the same pain with my kids today - even as I work to lessen the stress with the Kumon classes, the Berries, all the enrichment classes in school, the CD-ROMs we buy, the Chinese books we read etc. Still painful. Some things never change.
Note though that I don't think Chinese is uncool in any way. I like the language - now. But not then. We are all different in how, why and when we warm up to the language. For me, I find a greater interest in Chinese now than I ever had in school. I actually derive pleasure in ploughing through a Chinese book, armed with a dictionary which I would painstakingly comb to understand the word/meaning etc. I find a great deal of elegance, beauty and poetry in the lyricism of its phrases, some phrases even the English language would find hard to convey in similar style!
However, as a parent, I wish the system would (1) allow our kids choice to choose an Asian language (Mandarin, Malay, Japanese, Hindi, Tamil), not just plonk us according to race and (2) make learning this fun and engaging and (3) if examinable, would not lump lang grades with English, Math and Sci in the final PSLE scores. IMO, it might be a better indication of academic ability if one took MT out of it. Finally, (4) not link MT grades with entry into institutions of higher learning.
The billionaire got it right - successful language acquisition stems largely from enthusiasm.
But of course, having the moolah to have live-in nannies from China never hurt too!
Friday, June 27, 2008
"Mummy I will carry your ashes!"
These words came from Mr Owain the other day. It was part of our late-night-before-sleep talks.
We were lying in bed, talking about nothing in particular and then we started talking about how much we loved each other. I had told the children before of a particular clause in my will. I had stipulated that I desired to be cremated and upon cremation, my ashes would not be interred in a crematorium but will be placed in a pot of jasmine (or a sweet-scented flowering plant since I now realise how difficult it was to care for jasmine after my existing pot got infested with bugs and failed to bloom!). This pot of jasmine will be given to Owain to care for.
When I first told the children this, they all squealed in horror except Owain, whose eyes shone. KH gave me an icky glare too but I don't care. This is true. It is in my will. I have chosen Owain to carry my ashes.
So that night when we talked, it was already quite a few months after I first revealed this part of the will. But Owain still remembered it.
He said, "Mummy, I will always always love you. I will carry your ashes with me and take good care of them."
"You'll carry them all the time?"
"All the time."
"Even when you go for swimming lessons?"
"Yes."
"But I'd get wet. And wet ashes will just dissolved into the water!"
"Oh. Then I will place you at the side of the pool."
"Someone might knock me over."
"Oh. Then I will not go swimming. I will sit with you."
"No," I said, giving him a hug. "Go swimming darling. Leave mummy at home."
"But you will be so lonely at home!"
"No, I will be alright. Thank you for taking care of me."
"Even when you're ashes mummy. I will always love you."
"I will love you always too. Even when I am ashes."
And that snippet of conversation, is exactly why I love my little fishball boy so fiercely, so much, with such a deep passion. I cannot imagine him growing up and (selfishly so) away from me. I cannot bear him no longer loving me with the innocence and passion of his childhood and babyhood. Yet everyday that he grows, I lose him a little, bit by bit.
These words came from Mr Owain the other day. It was part of our late-night-before-sleep talks.
We were lying in bed, talking about nothing in particular and then we started talking about how much we loved each other. I had told the children before of a particular clause in my will. I had stipulated that I desired to be cremated and upon cremation, my ashes would not be interred in a crematorium but will be placed in a pot of jasmine (or a sweet-scented flowering plant since I now realise how difficult it was to care for jasmine after my existing pot got infested with bugs and failed to bloom!). This pot of jasmine will be given to Owain to care for.
When I first told the children this, they all squealed in horror except Owain, whose eyes shone. KH gave me an icky glare too but I don't care. This is true. It is in my will. I have chosen Owain to carry my ashes.
So that night when we talked, it was already quite a few months after I first revealed this part of the will. But Owain still remembered it.
He said, "Mummy, I will always always love you. I will carry your ashes with me and take good care of them."
"You'll carry them all the time?"
"All the time."
"Even when you go for swimming lessons?"
"Yes."
"But I'd get wet. And wet ashes will just dissolved into the water!"
"Oh. Then I will place you at the side of the pool."
"Someone might knock me over."
"Oh. Then I will not go swimming. I will sit with you."
"No," I said, giving him a hug. "Go swimming darling. Leave mummy at home."
"But you will be so lonely at home!"
"No, I will be alright. Thank you for taking care of me."
"Even when you're ashes mummy. I will always love you."
"I will love you always too. Even when I am ashes."
And that snippet of conversation, is exactly why I love my little fishball boy so fiercely, so much, with such a deep passion. I cannot imagine him growing up and (selfishly so) away from me. I cannot bear him no longer loving me with the innocence and passion of his childhood and babyhood. Yet everyday that he grows, I lose him a little, bit by bit.
Animal love to the rescue!
Had a brainwave I needed to share. I think getting Gillian to volunteer with an organisation that works with animals might be a good way of keeping her centred, and hopefully staving off the less than desirable influences she gets from her friends.
Latest harrowing incident in her school that rang alarm bells in my head - Gillian was called up to the VP's office because she had witnessed an incident in class. One of her friends had brought a penknife to school. Another girl took the penknife and started slashing her arms with it. Gillian said there was so much blood and the cut was so deep you could see the white of the fatty layer.
KH and I talked about our concerns and worry for her this morning in the car. We came to the conclusion that there was nothing much we could do to change the situation or protect her - she was in school for so many hours a day, away from us, and she was entering a phase in life when peer opinion and approval were important to her. Much though we would love to keep her in a bubble and let her emerge only when she was 30, this is not going to be possible. We're going to have to learn to trust a bit more, let go a bit more and then channel her and her energies into situations which are not so volatile in nature.
Gillian likes animals, particularly dogs and cats. So I'm thinking that a good way to keep her feet on the ground is to nurture her love and her knack for animals. Volunteering at the Zoo or at the SPCA might be a good start. It would be a different circle of friends that she would get to know - and I don't know if I am being naive or sweeping but I think people who love animals and care for animals usually tend to be more sensible, loving, kind and responsible. Certainly they would not place "boyfriends", "gangs", "emo slashing", "truancy" at the top of their list of priorities. I think the idea of volunteering and in an animal-care environment, would be good for her.
KH thinks its a good idea too. We're hoping some positive vibes from the animals and the animal-care situation, would rub off on her! Let's be clear - Gillian is still very much the girl I know, she is, right now (and I hope I am not hexing myself by writing this!) quite sensible about things, but as I told KH, she is only 13 - she's still got 14, 15, 16, 17, 18 and 19 to go!!! And in any one of those years, at any time, things could change just like that! But I hope to change the course of the river before it ever hits any rough patches. Am I being delusional or blindly optimistic? Both are different sides of the same coin. Will start exploring this option further...
Footnote to the slashing incident: Gill says the girl came back to school the next day - with clear cane marks on her. She said that girl was caned and belted for her actions.
I think slashing yourself is stupid. I also think it is a cry for help. And I think it is doubly stupid of parents to cane someone so clearly crying out for some help and connection. What good would caning do? I am speculating but maybe caning is the only course of action familiar to those parents, one they have resorted to in the past that actually worked? But the thing is, how do you impart the lesson of hurt to someone who would readily hurt herself? Things are already too far gone for that.
But if I feel for this girl, let me also say that I feel even more for her parents. I know I would feel so terrible - fearful, helpless, sad, angry, worried, if all that happened to Gillian. So maybe they lashed out in the midst of these powerful emotions. I hope they find their way and I hope I never have to go there.
Had a brainwave I needed to share. I think getting Gillian to volunteer with an organisation that works with animals might be a good way of keeping her centred, and hopefully staving off the less than desirable influences she gets from her friends.
Latest harrowing incident in her school that rang alarm bells in my head - Gillian was called up to the VP's office because she had witnessed an incident in class. One of her friends had brought a penknife to school. Another girl took the penknife and started slashing her arms with it. Gillian said there was so much blood and the cut was so deep you could see the white of the fatty layer.
KH and I talked about our concerns and worry for her this morning in the car. We came to the conclusion that there was nothing much we could do to change the situation or protect her - she was in school for so many hours a day, away from us, and she was entering a phase in life when peer opinion and approval were important to her. Much though we would love to keep her in a bubble and let her emerge only when she was 30, this is not going to be possible. We're going to have to learn to trust a bit more, let go a bit more and then channel her and her energies into situations which are not so volatile in nature.
Gillian likes animals, particularly dogs and cats. So I'm thinking that a good way to keep her feet on the ground is to nurture her love and her knack for animals. Volunteering at the Zoo or at the SPCA might be a good start. It would be a different circle of friends that she would get to know - and I don't know if I am being naive or sweeping but I think people who love animals and care for animals usually tend to be more sensible, loving, kind and responsible. Certainly they would not place "boyfriends", "gangs", "emo slashing", "truancy" at the top of their list of priorities. I think the idea of volunteering and in an animal-care environment, would be good for her.
KH thinks its a good idea too. We're hoping some positive vibes from the animals and the animal-care situation, would rub off on her! Let's be clear - Gillian is still very much the girl I know, she is, right now (and I hope I am not hexing myself by writing this!) quite sensible about things, but as I told KH, she is only 13 - she's still got 14, 15, 16, 17, 18 and 19 to go!!! And in any one of those years, at any time, things could change just like that! But I hope to change the course of the river before it ever hits any rough patches. Am I being delusional or blindly optimistic? Both are different sides of the same coin. Will start exploring this option further...
Footnote to the slashing incident: Gill says the girl came back to school the next day - with clear cane marks on her. She said that girl was caned and belted for her actions.
I think slashing yourself is stupid. I also think it is a cry for help. And I think it is doubly stupid of parents to cane someone so clearly crying out for some help and connection. What good would caning do? I am speculating but maybe caning is the only course of action familiar to those parents, one they have resorted to in the past that actually worked? But the thing is, how do you impart the lesson of hurt to someone who would readily hurt herself? Things are already too far gone for that.
But if I feel for this girl, let me also say that I feel even more for her parents. I know I would feel so terrible - fearful, helpless, sad, angry, worried, if all that happened to Gillian. So maybe they lashed out in the midst of these powerful emotions. I hope they find their way and I hope I never have to go there.
This and that...
Reporting in to say that Trin passed her hearing test with flying colours so hearing loss is not the issue with her poor speech. We start speech therapy next week so hopefully she will make tracks soon!
Term has started again and Cait started that off with a no-show on the first day of school. As usual, she cried and refused to go to school. And I was stressing about it because I was in the office and she was carrying on like that at home. It was frustrating and maddening to say the least. Vivian was in town and happened to visit the poly that day and witnessed my pain. So she said (very sensibly I thought): "Look, she is doing all this because she wants some attention. So she calls and cries and you agonise over it. Don't give her that attention. If she does not want to go to school, fine. Stay home. Deal with it when you get home then."
I stopped to think about it and realised she was right. So I told Lolita not to push things - if she didn't want to go to school, let her stay home and I would deal with it.
So what did I do?
Well, yes I have to confess that my instinct was to reach for the cane and deal a few lashes of it. But that was in the heat of anger. When I had stopped seething, I decided to call her bluff instead.
So I went home and coolly told my recalcitrant daughter: "If you don't want to go to school, that's fine. I will take you out of school. Its as simple as that. You can stay home. But then that means you don't learn anything. And no matter how smart you are, as long as you don't learn anything or work your brains, it will get soft and lazy and forgetful. And that is not really all that smart isn't it? So all your friends in school, your cousins, will all learn more than you will. But its your choice. I leave it to you. Just let me know. Tomorrow if you don't want to go to school again, then I take it you have decided. I will just write Mrs Bheem your principal, a nice email to say you won't be coming to school anymore."
I stressed that what upset me was that her behavior upset all of us and makes it hard for us to do things we have to do - It was stressful and hard for Lolita to do her job - that is, get her off to school on time. Poor Lolita has to listen to the screams, cajole, persuade etc to get her going. And, I continued, "Your crying and calling me or daddy at work to say you don't want to go to school stresses us out in the office, especially when both daddy and I were pushing bad deadlines and we've got important things to finish in the office etc." So to make it easy for everyone, I ended, if she did not want to go to school, she should just let us know and we would respect that.
As it was also library night, she was grounded from the library to drive the point home that I was displeased with her behavior. But the next day, and in the days since then, there has been no trouble. No phone call from home at 11am to moan about school, no flustered call from poor Lolita, nada. She went to school calmly. And at the end of the day when she gets home, rosy-cheeked and messy-haired, she is cheerful and says, whenever I ask, that school is "Great!" or "Very fun!"
When she told me: "See mom, I didn't cry today! I went to school!" I kept my response neutral and bland - I did not want to praise her for doing something which she knows has to be done. I believe in praise when appropriate, but not over-praising either. And for something which I feel is really a non-negotiable issue, which she should know better about, I do not think praising is warranted. So I just kept my response to a non-committal "Hmm." or "Okay." Or I just smiled briefly.
This thing about praising children. Sometimes I think we parents go a bit overboard in our enthusiasm to build confidence, self-esteem etc through praise. We praise them for every little thing. Soon praise becomes common, over-rated and then the bar gets raised - how much more enthusiastically can we praise? And even when we praise, how specific are we? Like we say to babies who take a few steps or reach a milestone: "Good boy!"
Sometimes when I catch myself saying that I think: Gee it sounds like I'm talking to my pet dog!
I think we need to be a bit more circumspect, balanced and specific in our praise. So if a child puts the right coloured block in the right spot, I would smile and say: "That's right!" but I would not say stuff like: "Good boy!" or "So clever!"
And I certainly would not praise a child for being polite, or for choosing to do the right thing. Any approval would come in appropriate forms eg. If a child brought me a drink, I'd say "Thank you".
But I would not gush: "Oh that is so sweet of you! How wonderful of you to bring me a drink! That is so nice of you! Such a kind little girl!"
I take it that politeness, respect, honesty, courtesy etc are given behavior. And in Cait's case, I think we did it wrong earlier in the year. We catered to the noise. We gave in to the mollycoddle. We scratched our heads, indulged in all the angsting phone calls, pleaded, threatened, rewarded, praised, bent backwards to get her to go. What should clearly have been a non-negotiable issue from the start.
This experience has made me reflect on praise, on the value of praise, how its effectiveness, and on dealing with a child honestly, calmly and factually. I think when we leave the emo out of it, it becomes apparent that we're serious. So if I had yelled at Cait: "You don't want to go?? FINE! You're grounded for life! I'll take you out of school! Go on then, be a goondu why don't you!!" Honestly, how seriously would she have taken it?
So maybe its just better to be factual. But play the right cards of course - I knew which buttons to push. She was a high-achieving, perfectionist, approval-seeking, competitive sort. So she would not want to 'lose out' in any way. Might not work with every child, but I feel it works with Cait.
Reporting in to say that Trin passed her hearing test with flying colours so hearing loss is not the issue with her poor speech. We start speech therapy next week so hopefully she will make tracks soon!
Term has started again and Cait started that off with a no-show on the first day of school. As usual, she cried and refused to go to school. And I was stressing about it because I was in the office and she was carrying on like that at home. It was frustrating and maddening to say the least. Vivian was in town and happened to visit the poly that day and witnessed my pain. So she said (very sensibly I thought): "Look, she is doing all this because she wants some attention. So she calls and cries and you agonise over it. Don't give her that attention. If she does not want to go to school, fine. Stay home. Deal with it when you get home then."
I stopped to think about it and realised she was right. So I told Lolita not to push things - if she didn't want to go to school, let her stay home and I would deal with it.
So what did I do?
Well, yes I have to confess that my instinct was to reach for the cane and deal a few lashes of it. But that was in the heat of anger. When I had stopped seething, I decided to call her bluff instead.
So I went home and coolly told my recalcitrant daughter: "If you don't want to go to school, that's fine. I will take you out of school. Its as simple as that. You can stay home. But then that means you don't learn anything. And no matter how smart you are, as long as you don't learn anything or work your brains, it will get soft and lazy and forgetful. And that is not really all that smart isn't it? So all your friends in school, your cousins, will all learn more than you will. But its your choice. I leave it to you. Just let me know. Tomorrow if you don't want to go to school again, then I take it you have decided. I will just write Mrs Bheem your principal, a nice email to say you won't be coming to school anymore."
I stressed that what upset me was that her behavior upset all of us and makes it hard for us to do things we have to do - It was stressful and hard for Lolita to do her job - that is, get her off to school on time. Poor Lolita has to listen to the screams, cajole, persuade etc to get her going. And, I continued, "Your crying and calling me or daddy at work to say you don't want to go to school stresses us out in the office, especially when both daddy and I were pushing bad deadlines and we've got important things to finish in the office etc." So to make it easy for everyone, I ended, if she did not want to go to school, she should just let us know and we would respect that.
As it was also library night, she was grounded from the library to drive the point home that I was displeased with her behavior. But the next day, and in the days since then, there has been no trouble. No phone call from home at 11am to moan about school, no flustered call from poor Lolita, nada. She went to school calmly. And at the end of the day when she gets home, rosy-cheeked and messy-haired, she is cheerful and says, whenever I ask, that school is "Great!" or "Very fun!"
When she told me: "See mom, I didn't cry today! I went to school!" I kept my response neutral and bland - I did not want to praise her for doing something which she knows has to be done. I believe in praise when appropriate, but not over-praising either. And for something which I feel is really a non-negotiable issue, which she should know better about, I do not think praising is warranted. So I just kept my response to a non-committal "Hmm." or "Okay." Or I just smiled briefly.
This thing about praising children. Sometimes I think we parents go a bit overboard in our enthusiasm to build confidence, self-esteem etc through praise. We praise them for every little thing. Soon praise becomes common, over-rated and then the bar gets raised - how much more enthusiastically can we praise? And even when we praise, how specific are we? Like we say to babies who take a few steps or reach a milestone: "Good boy!"
Sometimes when I catch myself saying that I think: Gee it sounds like I'm talking to my pet dog!
I think we need to be a bit more circumspect, balanced and specific in our praise. So if a child puts the right coloured block in the right spot, I would smile and say: "That's right!" but I would not say stuff like: "Good boy!" or "So clever!"
And I certainly would not praise a child for being polite, or for choosing to do the right thing. Any approval would come in appropriate forms eg. If a child brought me a drink, I'd say "Thank you".
But I would not gush: "Oh that is so sweet of you! How wonderful of you to bring me a drink! That is so nice of you! Such a kind little girl!"
I take it that politeness, respect, honesty, courtesy etc are given behavior. And in Cait's case, I think we did it wrong earlier in the year. We catered to the noise. We gave in to the mollycoddle. We scratched our heads, indulged in all the angsting phone calls, pleaded, threatened, rewarded, praised, bent backwards to get her to go. What should clearly have been a non-negotiable issue from the start.
This experience has made me reflect on praise, on the value of praise, how its effectiveness, and on dealing with a child honestly, calmly and factually. I think when we leave the emo out of it, it becomes apparent that we're serious. So if I had yelled at Cait: "You don't want to go?? FINE! You're grounded for life! I'll take you out of school! Go on then, be a goondu why don't you!!" Honestly, how seriously would she have taken it?
So maybe its just better to be factual. But play the right cards of course - I knew which buttons to push. She was a high-achieving, perfectionist, approval-seeking, competitive sort. So she would not want to 'lose out' in any way. Might not work with every child, but I feel it works with Cait.
Friday, June 20, 2008
Caitlin and Trin updates
Sent Cait for testing at DAS for dyslexia. The assessment covered reading fluency, literacy levels and cognitive abilities.
Turns out that despite the letter reversals, the lack of interest in reading etc, that she is not dyslexic after all. In terms of cognitive abilities, she scored very well and has an IQ higher than Isaac's, in the High Average range, just a notch shy of the Superior range. So that was a pleasant surprise.
There are red flags though. While she scored within the average bandset for phonological awareness and working memory, she scored very highly for others eg verbal and non-verbal reasoning skills and abilities. The differential gap between the high scores and the low average scores does throw up a warning that these would need to be addressed. For now she is coping well, but the psychologist warned that as the work got harder and working memory is more in demand, then she might start to struggle. She recommended strategies to help develop her working memory and phono awareness - games, websites etc.
We will get the detailed report in 6 weeks. But so far, this is good news for us. On the not-so-good side, this means we can't seek exemption for Chinese! But given her cognitive abilities and the fact that she scored higher than Isaac in phono awareness (Isaac scored in the significantly clinically poor range) we think she might just be able to manage better in the language - with enough help of course.
The Berries class seems to be helping a bit. She is taking the Higher Chinese P1 class and seems to be okay, and because this is at a higher level than what she takes in school, it helps I suppose.
This has been a week of psychological testing and evaluation. First Isaac, then Cait and now Trin.
I brought Trin to KKH to see the paeds there after getting a referral from the polyclinic. The paed there agreed that Trin is significantly delayed in speech development and has referred her to speech therapy.
I was pleasantly surprised at the speed at which an appointment was given. She will start therapy on 3 July and will go for a hearing test next Tuesday. The hearing test is given as a routine to rule out any anomaly - the doctor said some children may not have hearing loss but may not be able to hear certain pitches and sounds which then hampers their ability to say those sounds and form words appropriately.
Given Isaac's past experience at KKH, I was doubtful that she would be given an early slot, at least not one this early. So I was really happy to hear that she's got one starting in two weeks - I was hoping for one within 3 months! Hopefully she will pick up faster after this.
Sent Cait for testing at DAS for dyslexia. The assessment covered reading fluency, literacy levels and cognitive abilities.
Turns out that despite the letter reversals, the lack of interest in reading etc, that she is not dyslexic after all. In terms of cognitive abilities, she scored very well and has an IQ higher than Isaac's, in the High Average range, just a notch shy of the Superior range. So that was a pleasant surprise.
There are red flags though. While she scored within the average bandset for phonological awareness and working memory, she scored very highly for others eg verbal and non-verbal reasoning skills and abilities. The differential gap between the high scores and the low average scores does throw up a warning that these would need to be addressed. For now she is coping well, but the psychologist warned that as the work got harder and working memory is more in demand, then she might start to struggle. She recommended strategies to help develop her working memory and phono awareness - games, websites etc.
We will get the detailed report in 6 weeks. But so far, this is good news for us. On the not-so-good side, this means we can't seek exemption for Chinese! But given her cognitive abilities and the fact that she scored higher than Isaac in phono awareness (Isaac scored in the significantly clinically poor range) we think she might just be able to manage better in the language - with enough help of course.
The Berries class seems to be helping a bit. She is taking the Higher Chinese P1 class and seems to be okay, and because this is at a higher level than what she takes in school, it helps I suppose.
This has been a week of psychological testing and evaluation. First Isaac, then Cait and now Trin.
I brought Trin to KKH to see the paeds there after getting a referral from the polyclinic. The paed there agreed that Trin is significantly delayed in speech development and has referred her to speech therapy.
I was pleasantly surprised at the speed at which an appointment was given. She will start therapy on 3 July and will go for a hearing test next Tuesday. The hearing test is given as a routine to rule out any anomaly - the doctor said some children may not have hearing loss but may not be able to hear certain pitches and sounds which then hampers their ability to say those sounds and form words appropriately.
Given Isaac's past experience at KKH, I was doubtful that she would be given an early slot, at least not one this early. So I was really happy to hear that she's got one starting in two weeks - I was hoping for one within 3 months! Hopefully she will pick up faster after this.
Wednesday, June 11, 2008
Isaac's results
Isaac has now officially been diagnosed with Asperger's Syndrome (Autistic Spectrum Disorders).
He is a high-functioning AS kid with an IQ in the High Average range. He stands on the 87th percentile of his peer group. What this means is that in a room of 100 kids his age, he would have an IQ higher than 87 of them. On almost all tests, he is scoring well above his grade range. In the North American context (where the tests come from), his current grade would be grade 6.5 (.5 because halfway through the school year) in local terms, Pri 6. But in his test scores, Isaac consistently performs at higher grades (7.5 to 13.5) with the exception being 5.3 for handwriting! Note that grade 12 is equivalent to 17-18 year-olds in the American school system.
As a matter of interest, she said that Singaporean children do tend to score slightly higher than their North American peers - possibly thanks to the school system. But even after adjusting for cultural differences, at a confidence level of 68%, Isaac's scores were still pretty high.
The testing was pretty comprehensive. His scores in all areas range from highly average to highly superior. His working memory scored 99.7 - in the highly superior range. So if you told him: "duck 6 horse car 9 4 spoon 3 10 1 elephant hat tractor" he would be able to remember all that and reel it back off to you. The psychologist said she was quite excited during that test because it was so rare to see someone doing this, despite her years of testing.
He had one borderline score in phonemic awareness - that means he is unable to discern sounds to put words together. For example, instead of saying "Apple", you say "ah-el" (taking out the P sound), he would not be able to discern what the word is. For that test, he scored 0.5. With a score this poor, it would be hard for him to learn Chinese because of the different tones/intonations the language requires. Whereas in a language that is romanised eg Malay or French, it would be easier because his reading skills are very strong. We asked if there is something we could do to improve this, but apparently there isn't much to be done because this is just how his brain processes sounds. Its got nothing to do with pinyin or with phonics because other tests demonstrate that he is well able to use phonics to blend sounds etc. For example, one test was on spelling and he was asked to spell 'vacillate' - he spelled it as 'vaselate' which is consistently with the phonic sounds of the word. So he is using phonic rules and he is aware of them, but his brain just cannot connect the dots re phonemic awareness.
With all the interviews, the questionnaires that KH and I filled out, Isaac also filled one out and plus her clinical observations of him during that time, and assessing him on the Gilliam Aspergers Disorders Scale and the Gilliam Autism Rating Scales, Isaac was finally diagnosed with Aspergers'.
The psychologist also gave a letter of recommendation in support of exemption for Chinese. This is because of (1) the AS diagnosis, (2) his poor phonemic awareness scores and (3) consistently failing Chinese badly for all his school life.
She mentioned that MOE is now increasingly strict with exemptions - there was apparently a trend of 'wrongly diagnosed' dyslexics who got exemption, so MOE is now more cautious in granting exemptions. She said that there have been many children who have been assessed by her for the same reason - seeking exemption - but she has not always supported them all. For her own professional credibility, she says she has to be very strict on assessments and diagnoses. In Isaac's case, however, there are clearly grounds for exemption so she is recommending for it.
KH was very happy to hear that! Well, that is half the battle won. So next step is to start the exemption application process tomorrow.
After our meeting with the psychologist, I felt very light. Like a burden just got lifted. I feel... vindicated, I suppose.
After years of not really knowing, only suspecting, being told by KKH that Isaac could not conclusively be defined as autistic but neither could he be defined as normal, finally, finally, finally I have an answer. It is not that he was not autistic, nor that he was under-stimulated, nor that he was 'cured' or came out of it. It was hard telling people I believe he is autistic only to be met with doubtful looks and comments like "No lah... are you sure? He looks so normal! If you hadn't told me, I would not have known!" That makes me look like someone with Munchausen Syndrome!! Attention-seeking mother who makes kids out to be ill! Argh!
The psychological testing proved me right.
He IS autistic. He has Asperger's Syndrome. And reading about AS this morningd, I quote this passage from Tony Attwood's book 'Asperger's Syndrome - A Guide for Parents and Professionals': "...a proportion of children who had the classic signs of autism in their pre-school years may show significant improvement in communication and abilities. The previously withdrawn and severely language impaired child develops fluent speech and the ability for supported inclusion in an ordinary classroom. This improvement can be remarkably rapid and occur just before the age of five (Shah, 1988). We are not sure of this is a natural phenomenon for some children or a tribute to early intervention programmes; probably both. Nevertheless, the previous diagnosis of classic autism was accurate when the child was very young, but the child has progressed along the autistic continuum to the expression we call Asperger's Syndrome."
This fit Isaac's profile to a T. Early classic symptoms, non-verbal, poor language skills, atypical behavior, then with therapy, then suddenly very quick progress, language fluency, strong reading skills etc. By the age of 5, he appeared normal.
But bottomline is: he never got out of autism. He is just an AS kid. And this is how AS develops. Which makes me pissed with KKH now! Had they been more aware of the possibility of AS, or the characteristics that define the AS progression, they should have called for a more detailed, comprehensive psychological testing back then - instead, a lot of what they discerned was based on the fact that he had 'improved', from parents' observations (and heck, which parent would not be grateful to see improvement?!) No real testing was ever done.
The psychologist who did Isaac's testing yesterday told us as much - that the early therapy could have damped down the severity of the condition, but as he grows and social demands change, the differences will grow more obvious. As it has.
We were given several red flags to look out for - increasing social isolation for one, particularly as he enters teenhood. He is also classified to be 'at-risk' of depression because of his social isolation. There is still so much to absorb and to ponder. KH and I will have our work cut out for us. But for now, I just feel a deep sense of relief.
Isaac has now officially been diagnosed with Asperger's Syndrome (Autistic Spectrum Disorders).
He is a high-functioning AS kid with an IQ in the High Average range. He stands on the 87th percentile of his peer group. What this means is that in a room of 100 kids his age, he would have an IQ higher than 87 of them. On almost all tests, he is scoring well above his grade range. In the North American context (where the tests come from), his current grade would be grade 6.5 (.5 because halfway through the school year) in local terms, Pri 6. But in his test scores, Isaac consistently performs at higher grades (7.5 to 13.5) with the exception being 5.3 for handwriting! Note that grade 12 is equivalent to 17-18 year-olds in the American school system.
As a matter of interest, she said that Singaporean children do tend to score slightly higher than their North American peers - possibly thanks to the school system. But even after adjusting for cultural differences, at a confidence level of 68%, Isaac's scores were still pretty high.
The testing was pretty comprehensive. His scores in all areas range from highly average to highly superior. His working memory scored 99.7 - in the highly superior range. So if you told him: "duck 6 horse car 9 4 spoon 3 10 1 elephant hat tractor" he would be able to remember all that and reel it back off to you. The psychologist said she was quite excited during that test because it was so rare to see someone doing this, despite her years of testing.
He had one borderline score in phonemic awareness - that means he is unable to discern sounds to put words together. For example, instead of saying "Apple", you say "ah-el" (taking out the P sound), he would not be able to discern what the word is. For that test, he scored 0.5. With a score this poor, it would be hard for him to learn Chinese because of the different tones/intonations the language requires. Whereas in a language that is romanised eg Malay or French, it would be easier because his reading skills are very strong. We asked if there is something we could do to improve this, but apparently there isn't much to be done because this is just how his brain processes sounds. Its got nothing to do with pinyin or with phonics because other tests demonstrate that he is well able to use phonics to blend sounds etc. For example, one test was on spelling and he was asked to spell 'vacillate' - he spelled it as 'vaselate' which is consistently with the phonic sounds of the word. So he is using phonic rules and he is aware of them, but his brain just cannot connect the dots re phonemic awareness.
With all the interviews, the questionnaires that KH and I filled out, Isaac also filled one out and plus her clinical observations of him during that time, and assessing him on the Gilliam Aspergers Disorders Scale and the Gilliam Autism Rating Scales, Isaac was finally diagnosed with Aspergers'.
The psychologist also gave a letter of recommendation in support of exemption for Chinese. This is because of (1) the AS diagnosis, (2) his poor phonemic awareness scores and (3) consistently failing Chinese badly for all his school life.
She mentioned that MOE is now increasingly strict with exemptions - there was apparently a trend of 'wrongly diagnosed' dyslexics who got exemption, so MOE is now more cautious in granting exemptions. She said that there have been many children who have been assessed by her for the same reason - seeking exemption - but she has not always supported them all. For her own professional credibility, she says she has to be very strict on assessments and diagnoses. In Isaac's case, however, there are clearly grounds for exemption so she is recommending for it.
KH was very happy to hear that! Well, that is half the battle won. So next step is to start the exemption application process tomorrow.
After our meeting with the psychologist, I felt very light. Like a burden just got lifted. I feel... vindicated, I suppose.
After years of not really knowing, only suspecting, being told by KKH that Isaac could not conclusively be defined as autistic but neither could he be defined as normal, finally, finally, finally I have an answer. It is not that he was not autistic, nor that he was under-stimulated, nor that he was 'cured' or came out of it. It was hard telling people I believe he is autistic only to be met with doubtful looks and comments like "No lah... are you sure? He looks so normal! If you hadn't told me, I would not have known!" That makes me look like someone with Munchausen Syndrome!! Attention-seeking mother who makes kids out to be ill! Argh!
The psychological testing proved me right.
He IS autistic. He has Asperger's Syndrome. And reading about AS this morningd, I quote this passage from Tony Attwood's book 'Asperger's Syndrome - A Guide for Parents and Professionals': "...a proportion of children who had the classic signs of autism in their pre-school years may show significant improvement in communication and abilities. The previously withdrawn and severely language impaired child develops fluent speech and the ability for supported inclusion in an ordinary classroom. This improvement can be remarkably rapid and occur just before the age of five (Shah, 1988). We are not sure of this is a natural phenomenon for some children or a tribute to early intervention programmes; probably both. Nevertheless, the previous diagnosis of classic autism was accurate when the child was very young, but the child has progressed along the autistic continuum to the expression we call Asperger's Syndrome."
This fit Isaac's profile to a T. Early classic symptoms, non-verbal, poor language skills, atypical behavior, then with therapy, then suddenly very quick progress, language fluency, strong reading skills etc. By the age of 5, he appeared normal.
But bottomline is: he never got out of autism. He is just an AS kid. And this is how AS develops. Which makes me pissed with KKH now! Had they been more aware of the possibility of AS, or the characteristics that define the AS progression, they should have called for a more detailed, comprehensive psychological testing back then - instead, a lot of what they discerned was based on the fact that he had 'improved', from parents' observations (and heck, which parent would not be grateful to see improvement?!) No real testing was ever done.
The psychologist who did Isaac's testing yesterday told us as much - that the early therapy could have damped down the severity of the condition, but as he grows and social demands change, the differences will grow more obvious. As it has.
We were given several red flags to look out for - increasing social isolation for one, particularly as he enters teenhood. He is also classified to be 'at-risk' of depression because of his social isolation. There is still so much to absorb and to ponder. KH and I will have our work cut out for us. But for now, I just feel a deep sense of relief.
Monday, June 09, 2008
Isaac's psychological evaluation
Two weeks ago, we sent Isaac for his psychological eval. It was a 4-hour test with an attractive, soft-spoken Canadian psychologist. The evaluation, including a review session and a full report, cost us $1000. Ouch.
KH says that if the psych eval comes up with something to support an exemption from Chinese, it would be money well-spent. If it does not, he would personally make the psychologist re-write the report! Mr Sledgehammer KH at his subtle best here.
I think it will go decently well. At least I hope so, I hope my gut feel is not wrong. By definition and observation, Isaac's eye contact is poor, fleeting at best; his discomfort in social situations etc all reflected strongly in reports from his teachers, from his therapist and from us as parents. He still has some faint remnant of his autistic behavior - finger stimming, echolalia.
In the cognitive tests, the psychologist told us that Isaac performed very well in some tests and not so well in others. One test that he did very well in was an auditory processing test where the tape recorder spewed out some words in quick succession and Isaac had to repeat those in the correct order. It got harder and harder as the mix of words and numbers got longer and longer. The highest score was >31. Isaac scored 37. The psychologist said in her years of testing and scoring, she had never seen this kind of score.
I asked: if he could score so well, how come that does not translate into his grades? Is it because we do not push enough?
She replied: Could be. Or it could be the sign of an underlying learning disability.
He didn't score as well when pictograms were used. The psychologist said this could well indicate why he does not do well in Chinese because of the use of pictograms.
I can hope!
Well, we will know tomorrow. KH and I are due back in the psychologist office tomorrow evening for the review.
Fingers crossed please.
Two weeks ago, we sent Isaac for his psychological eval. It was a 4-hour test with an attractive, soft-spoken Canadian psychologist. The evaluation, including a review session and a full report, cost us $1000. Ouch.
KH says that if the psych eval comes up with something to support an exemption from Chinese, it would be money well-spent. If it does not, he would personally make the psychologist re-write the report! Mr Sledgehammer KH at his subtle best here.
I think it will go decently well. At least I hope so, I hope my gut feel is not wrong. By definition and observation, Isaac's eye contact is poor, fleeting at best; his discomfort in social situations etc all reflected strongly in reports from his teachers, from his therapist and from us as parents. He still has some faint remnant of his autistic behavior - finger stimming, echolalia.
In the cognitive tests, the psychologist told us that Isaac performed very well in some tests and not so well in others. One test that he did very well in was an auditory processing test where the tape recorder spewed out some words in quick succession and Isaac had to repeat those in the correct order. It got harder and harder as the mix of words and numbers got longer and longer. The highest score was >31. Isaac scored 37. The psychologist said in her years of testing and scoring, she had never seen this kind of score.
I asked: if he could score so well, how come that does not translate into his grades? Is it because we do not push enough?
She replied: Could be. Or it could be the sign of an underlying learning disability.
He didn't score as well when pictograms were used. The psychologist said this could well indicate why he does not do well in Chinese because of the use of pictograms.
I can hope!
Well, we will know tomorrow. KH and I are due back in the psychologist office tomorrow evening for the review.
Fingers crossed please.
Worry beads
I posted sometime ago about my concerns about Gillian's friends and how agonising it was to trust and to let go the reins.
Two weeks ago we had the parent-teacher meeting with Gillian's form teacher. Well, the warning bells have officially started their peal.
I asked Mr ST about her friends, the ones whose names she constantly mentions, whose company she enjoys. There was some hesitation but he came clean with me and I am grateful for his honesty.
Her friends, he explained carefully, are the trouble brigade in class. They have had complaints from the public for bad behavior at Parkway, at the beach nearby, at the bus-stop outside school etc. Parents have also complained. It wasn't only about bad behavior but also public snogging with boys. These girls, he said, have very poor parental control. He warned me to look out for changed behavior - like Gillian not coming home straight after school, being defiant, lying etc. He said that girls whose behavior were not deemed problematic in the first term had been 'turned' by the second term. Their parents had observed this and had highlighted it to him. He acknowledged that it would be a hard problem because the trouble brigade always seems so attractive - they were loud, popular, outspoken etc and always seemed to have interesting fun lives. And, he shrugged, who would not want to have fun too?
I sighed. This was how it was going to be. I knew it, suspected it would happen and maybe I was in denial but I did not think it would happen so quickly.
He said Gillian is always sunny and well-behaved in class. She was not rude or noisy. I thanked him for his insight but left unspoken, hanging above our heads, was the knowledge that this could change at any time.
I left the PTM worried and a bit heavy-hearted. What could I do? How could I protect her? How could I influence her so that she made the right choices?
I went to the bowling alley to meet Gillian. It was the last bowling practice of the term. From there, we walked to Parkway Parade to meet KH, who would pick us up from there.
As we walked, I asked her: you know that time you went with your friends to Parkway... were there any uh, boys... there?
She looked at me: Of course mom! They went there to hang out with their boyfriends.
My eyebrows must have gone up because she continued: But don't worry mom. I didn't do anything. I'm not interested in boys and all that now. Besides, there's not even a cute one among them there!
As if that would reassure me!
She went on: You know today, when I called to ask you if I could go to the beach with them...
Uh-huh, I said. I said no, remember?
Yes I remember. Well, they wanted to go to the beach to meet the boys again.
My heart pumped. And she said: I said I had to call you to ask you and Charmaine said why I had to call you, everything also must call... She said I could just go to the beach and tell you that I had gone for bowling. You don't have to know. But I said I better call to check or I would get into trouble and then Charmaine just said aiyah, you don't go lah! so troublesome! But I called you anyway and you said no, so I went bowling.
Can I say how I felt in the last few minutes when she made that tiny speech? My heart went from anguish, to fear and then to relief and to pride.
Right then in the busy road, I gave my daughter a hug. Both of us were a bit embarrassed and tried to be cool about it. I nodded and said Gill, I am SO glad you did that. I'm so glad you called mummy. I'm so glad you didn't just go with them.
She scoffed: Of course I'd call and ask. If you found out, can you imagine how much trouble I will be in?? Don't worry mom, I know what to do.
I hope so. For now at least she knows what to do, she will call and ask and check and seek approval. But for how long? She has another 4 years in KC and then after that, so many years where there are mistakes ready to be made.
I am being pessimistic. I know there are mistakes. There inevitably will be. I know I can't shelter her from all this. I know I will keep getting heart attacks like this. I know that she will one day let me down. As I will one day let her down if I have not already. It will happen because we are all human.
But for now, at least for the moment, I am grateful that she sticks close to my shadow.
I try to remain non-committal about her friends. When we talked just yesterday, she said that she knew her friends always get into trouble. But not her, she said confidently. I said darkly, yes then I hope you change THEM and not they change YOU. I don't want to condemn her friends in front of her. I don't want to turn her against them. If I do, she will turn against me. But I want to create enough awareness of their choices and our values such that she knows what is right and will not be afraid to make choices that make her different or less accepted.
I find it tough and a struggle to balance, not to be so quick to warn her off her friends, and to project a 'neutral' stance. For instance, when I said that so-and-so should not have been so aggressive to start a fight in the toilet (the girl has since been disciplined and suspended), Gillian defended her. She shot back: You were not there. You don't know. The teachers don't know anything. It was not her fault at all! The other girl started it and yet she was not suspended! Its so unfair!
Yikes. Had to backpedal a bit.
While I fear for Gillian, I also feel for these girls - why do they not connect with their parents? Why is it so hard for them? I think of the twins and the family situation they come from and I find it hard to blame them. I feel sorry for them and I wish I could take them into my house. But at the same time, I am filled with strong protective feelings for MY brood. If I take these girls into my household, inviting them to come over, stay over etc., what influence will they have on my younger ones? Already, according to Mr ST some parents have complained of their bad behavior when they go over to their homes. When I raised the issue with Mr ST about including them in my household, he brightened visibly. That, he said, would be ideal - if you could help them and if Gillian could influence them instead of the other way around. And ideally yes, this would be good. But it would be a responsibility that I am reluctant to take on at the moment, no matter how much sympathy I have for them.
Why do mothers feel it so keenly? I don't think KH angsts about this as much. I have so much fear in me. Is this the way to parent? I don't think so. Are all parents filled wth this much worry? I keep going back to the image created by the words in the bible: "...and sorrow, like a sharp sword, shall pierce your heart." I know exactly how that feels.
The worry beads already keep poking at me inside.
I posted sometime ago about my concerns about Gillian's friends and how agonising it was to trust and to let go the reins.
Two weeks ago we had the parent-teacher meeting with Gillian's form teacher. Well, the warning bells have officially started their peal.
I asked Mr ST about her friends, the ones whose names she constantly mentions, whose company she enjoys. There was some hesitation but he came clean with me and I am grateful for his honesty.
Her friends, he explained carefully, are the trouble brigade in class. They have had complaints from the public for bad behavior at Parkway, at the beach nearby, at the bus-stop outside school etc. Parents have also complained. It wasn't only about bad behavior but also public snogging with boys. These girls, he said, have very poor parental control. He warned me to look out for changed behavior - like Gillian not coming home straight after school, being defiant, lying etc. He said that girls whose behavior were not deemed problematic in the first term had been 'turned' by the second term. Their parents had observed this and had highlighted it to him. He acknowledged that it would be a hard problem because the trouble brigade always seems so attractive - they were loud, popular, outspoken etc and always seemed to have interesting fun lives. And, he shrugged, who would not want to have fun too?
I sighed. This was how it was going to be. I knew it, suspected it would happen and maybe I was in denial but I did not think it would happen so quickly.
He said Gillian is always sunny and well-behaved in class. She was not rude or noisy. I thanked him for his insight but left unspoken, hanging above our heads, was the knowledge that this could change at any time.
I left the PTM worried and a bit heavy-hearted. What could I do? How could I protect her? How could I influence her so that she made the right choices?
I went to the bowling alley to meet Gillian. It was the last bowling practice of the term. From there, we walked to Parkway Parade to meet KH, who would pick us up from there.
As we walked, I asked her: you know that time you went with your friends to Parkway... were there any uh, boys... there?
She looked at me: Of course mom! They went there to hang out with their boyfriends.
My eyebrows must have gone up because she continued: But don't worry mom. I didn't do anything. I'm not interested in boys and all that now. Besides, there's not even a cute one among them there!
As if that would reassure me!
She went on: You know today, when I called to ask you if I could go to the beach with them...
Uh-huh, I said. I said no, remember?
Yes I remember. Well, they wanted to go to the beach to meet the boys again.
My heart pumped. And she said: I said I had to call you to ask you and Charmaine said why I had to call you, everything also must call... She said I could just go to the beach and tell you that I had gone for bowling. You don't have to know. But I said I better call to check or I would get into trouble and then Charmaine just said aiyah, you don't go lah! so troublesome! But I called you anyway and you said no, so I went bowling.
Can I say how I felt in the last few minutes when she made that tiny speech? My heart went from anguish, to fear and then to relief and to pride.
Right then in the busy road, I gave my daughter a hug. Both of us were a bit embarrassed and tried to be cool about it. I nodded and said Gill, I am SO glad you did that. I'm so glad you called mummy. I'm so glad you didn't just go with them.
She scoffed: Of course I'd call and ask. If you found out, can you imagine how much trouble I will be in?? Don't worry mom, I know what to do.
I hope so. For now at least she knows what to do, she will call and ask and check and seek approval. But for how long? She has another 4 years in KC and then after that, so many years where there are mistakes ready to be made.
I am being pessimistic. I know there are mistakes. There inevitably will be. I know I can't shelter her from all this. I know I will keep getting heart attacks like this. I know that she will one day let me down. As I will one day let her down if I have not already. It will happen because we are all human.
But for now, at least for the moment, I am grateful that she sticks close to my shadow.
I try to remain non-committal about her friends. When we talked just yesterday, she said that she knew her friends always get into trouble. But not her, she said confidently. I said darkly, yes then I hope you change THEM and not they change YOU. I don't want to condemn her friends in front of her. I don't want to turn her against them. If I do, she will turn against me. But I want to create enough awareness of their choices and our values such that she knows what is right and will not be afraid to make choices that make her different or less accepted.
I find it tough and a struggle to balance, not to be so quick to warn her off her friends, and to project a 'neutral' stance. For instance, when I said that so-and-so should not have been so aggressive to start a fight in the toilet (the girl has since been disciplined and suspended), Gillian defended her. She shot back: You were not there. You don't know. The teachers don't know anything. It was not her fault at all! The other girl started it and yet she was not suspended! Its so unfair!
Yikes. Had to backpedal a bit.
While I fear for Gillian, I also feel for these girls - why do they not connect with their parents? Why is it so hard for them? I think of the twins and the family situation they come from and I find it hard to blame them. I feel sorry for them and I wish I could take them into my house. But at the same time, I am filled with strong protective feelings for MY brood. If I take these girls into my household, inviting them to come over, stay over etc., what influence will they have on my younger ones? Already, according to Mr ST some parents have complained of their bad behavior when they go over to their homes. When I raised the issue with Mr ST about including them in my household, he brightened visibly. That, he said, would be ideal - if you could help them and if Gillian could influence them instead of the other way around. And ideally yes, this would be good. But it would be a responsibility that I am reluctant to take on at the moment, no matter how much sympathy I have for them.
Why do mothers feel it so keenly? I don't think KH angsts about this as much. I have so much fear in me. Is this the way to parent? I don't think so. Are all parents filled wth this much worry? I keep going back to the image created by the words in the bible: "...and sorrow, like a sharp sword, shall pierce your heart." I know exactly how that feels.
The worry beads already keep poking at me inside.
Friday, June 06, 2008
Trin's tantrums...
...are very exhausting to deal with. Or maybe I lack the energy and the patience to deal with this.
We just came home from Malaysia. There are tantrums everyday. Not a day goes by without at least one or two frantic screaming/crying bouts. The worst was when we left KL for Malacca and she cried for the duration of the 1.5hr journey in the car.
She just didn't want to be strapped in her carseat. Too bad, went KH. Sitting in her carseat when the car is moving is non-negotiable. The first half an hour was okay as the kids tried distracting her, offering her snacks, sweets, their toys etc. But after that, all bets were off.
She wriggled her way out of the shoulder harness, but remained strapped by the hip harness. She started yowling and screaming from that moment. It wasn't even the usual sort of crying - she was screaming in fury and frustration.
The atmosphere in the car was tense.
All the kids went quiet as they either slept or listened to Trin scream her way down the NS Highway. We gave everyone stern instructions to ignore her and not even look at her so as not to encourage her to scream further - not that she needed any encouragement! KH and I tried to ignore her screams and carry on normally. But in an enclosed space, with such ear-piercing shrieks, it was very hard to ignore. At first we tried having a conversation by yelling above the din in the car - near impossible. Got to a point when it was just too tiring to maintain a conversation with that kind of noise going on. So even we fell silent and just drove, eyes on the road, ears assaulted by the constant screaming.
I could take it well at first. But after more than 1 hr of this, even my nerves were shredded.
By the time we were about 20min away from the condo, her screams still had not lessened in ear-piercing intensity but there was now a hoarseness there. And she had started begging us. She wasn't just screaming out of anger anymore. The anger and frustration at being strapped had gone. She was just sobbing for help. She called us one by one. "Owain" "Ning Ning" "Ian" (which was how she pronounced Gillian) "Che-che" "Dad" "Mummy" and then, "Please..."
My God it was heartrending to hear.
I could live with screams. I could not live with my baby begging us like that. It was so hard to sit there and not reach back and pull her out. Every instinct that I had, every inch of my heart was calling me to pull her out. But KH remained firm - and I suppose, rightly so.
I turned my frustration and resentment to the slow drivers in front of us, those who blocked our way, all the cars ahead who happen to be in the same lane, cursing the slow traffic. I blamed car manufacturers. I cursed those lofty thoughts about child safety. I thought about how car seats went against all mother's natural instincts to keep babies close. I wished the car had never been invented. I wish we all went back to horse and carriage and no cars!
It was agonising to hear her beg but do nothing. KH told us we had to remain silent and not even talk to her. It would only make things worse since there is no way you can take her out, he said.
Gillian piped up from the backseat darkly: If she gets a sore throat it would be all your fault! What sort of parents are you anyway to let your baby cry like that!
Upset though I was then, I told Gillian sharply: better a sore throat than roadkill! Daddy is going at 130km/h. If anything happens, Trin is going to fly through the window. Would you like to be responsible for that? I would not.
Trin went on pleading and sobbing. We finally reached the condo and the first thing I did was get out to go pick her up from her carseat. But someone had beaten me to it.
Trin was already standing in the third row, Cait had her arms protectively around her in a hug. Both were already out of the carseat and booster. KH fumed: WHO took her out!!
Caitlin said in a small voice: I did.
It must have happened about five minutes before we arrived. I guess she could not take it anymore. So she unbelted herself, unbelted Trin and both of them sat/stood in the third row with Cait holding Trin. Trin must have been too tired to even try to get to the front by then.
I could not scold Cait.
So I just held Trin. Her little arms went round my neck and her tear-stained face and sweaty hair pressed against my shoulder, her body still heaving with silent hiccups and sobs. We stayed like this for a long time. Trin's eyes swelled to half their usual size and remained puffy until the next day.
I told KH: No more. The next time, we break the journey when she starts to cry. I don't care how long it takes for us to drive back home. I cannot take another one and a half hours of this kind of crying.
But there were no more tantrums about the carseat. For the rest of the journey, she obediently strapped down and apart from some restless fretful protests, she was quiet for the most part - even on the long journey back to Singapore.
In this power struggle, I guess we won. But it feels like a hollow victory.
KH feels vindicated. See, he said. It worked. Just gotta ignore her and she'll get the message that this is non-negotiable.
But I feel rotten to do this to her, necessary though I know it to be for her safety.
More troubling was the size and expression of her anger - the Car Tantrum would go down in the Chong family history for being a real humdinger of a tantrum. But tantrums are not new to Trin. She has other tantrums and will continue to have them.
We have gotten to the stage where everyone walks on eggshells around her. When we hear the slightest wail, angry scream, one of us will say: What does she want? Quick! Whatever she wants, give it to her!! Like a real tyrant, she has struck fear into all of us and that is not good. We fear the screams, we tense up whenever it happens and the whole atmosphere (in the car, or at home) goes flat immediately.
It is not ideal. The kids have been good-natured so far about indulging her. But this is not the answer. In fact I think it could be detrimental to her and to us in the long run in terms of family dynamics. Honestly I am not sure what to do. Standing up to her is like dropping a lit match in a dry forest!
I suspect its got to do with her poor expressive language - and the fact that she's got a very strong will. None of my other babies were ever like this. The only one who ever surpassed Trin in tantrum intensity is Isaac - and he had autistic tendencies! No, Trin is certainly not autistic. But I worry about the anger and the way she demonstrates this.
She can even get physically violent - no qualms about hitting us, even me. And her violence/tantrums extend even to her night terrors. We have had quite a few episodes when she 'wakes' in the middle of the night, screaming. Her eyes are unseeing but open. She flails her arms about, screams, wails, cries "No! No! No! I don't want! I don't want! There! There! THERE!!!" Then she'll tug at us, pull our clothes, smack us, arch her back and throw herself back on the bed, rolling around, getting up and doing it all over again. No amount of placation helps. Not even an offer of 'nen-nen'. KH tries to carry her and I try as well, but she rejects us, screaming all the way. After about 20min to half an hour of this, she will eventually get tired and take the nen-nen again when offered. So nowadays, when she gets like this in the middle of the night, I just sit and wait it out. No point saying or doing anything. Wait until she gets most of it out of her system, then offer her the nen-nen.
She has an appointment at KKH on the 16 of June for her speech delay issue. So I am definitely going to mention this. Meanwhile we continue to live in fear. :-)
...are very exhausting to deal with. Or maybe I lack the energy and the patience to deal with this.
We just came home from Malaysia. There are tantrums everyday. Not a day goes by without at least one or two frantic screaming/crying bouts. The worst was when we left KL for Malacca and she cried for the duration of the 1.5hr journey in the car.
She just didn't want to be strapped in her carseat. Too bad, went KH. Sitting in her carseat when the car is moving is non-negotiable. The first half an hour was okay as the kids tried distracting her, offering her snacks, sweets, their toys etc. But after that, all bets were off.
She wriggled her way out of the shoulder harness, but remained strapped by the hip harness. She started yowling and screaming from that moment. It wasn't even the usual sort of crying - she was screaming in fury and frustration.
The atmosphere in the car was tense.
All the kids went quiet as they either slept or listened to Trin scream her way down the NS Highway. We gave everyone stern instructions to ignore her and not even look at her so as not to encourage her to scream further - not that she needed any encouragement! KH and I tried to ignore her screams and carry on normally. But in an enclosed space, with such ear-piercing shrieks, it was very hard to ignore. At first we tried having a conversation by yelling above the din in the car - near impossible. Got to a point when it was just too tiring to maintain a conversation with that kind of noise going on. So even we fell silent and just drove, eyes on the road, ears assaulted by the constant screaming.
I could take it well at first. But after more than 1 hr of this, even my nerves were shredded.
By the time we were about 20min away from the condo, her screams still had not lessened in ear-piercing intensity but there was now a hoarseness there. And she had started begging us. She wasn't just screaming out of anger anymore. The anger and frustration at being strapped had gone. She was just sobbing for help. She called us one by one. "Owain" "Ning Ning" "Ian" (which was how she pronounced Gillian) "Che-che" "Dad" "Mummy" and then, "Please..."
My God it was heartrending to hear.
I could live with screams. I could not live with my baby begging us like that. It was so hard to sit there and not reach back and pull her out. Every instinct that I had, every inch of my heart was calling me to pull her out. But KH remained firm - and I suppose, rightly so.
I turned my frustration and resentment to the slow drivers in front of us, those who blocked our way, all the cars ahead who happen to be in the same lane, cursing the slow traffic. I blamed car manufacturers. I cursed those lofty thoughts about child safety. I thought about how car seats went against all mother's natural instincts to keep babies close. I wished the car had never been invented. I wish we all went back to horse and carriage and no cars!
It was agonising to hear her beg but do nothing. KH told us we had to remain silent and not even talk to her. It would only make things worse since there is no way you can take her out, he said.
Gillian piped up from the backseat darkly: If she gets a sore throat it would be all your fault! What sort of parents are you anyway to let your baby cry like that!
Upset though I was then, I told Gillian sharply: better a sore throat than roadkill! Daddy is going at 130km/h. If anything happens, Trin is going to fly through the window. Would you like to be responsible for that? I would not.
Trin went on pleading and sobbing. We finally reached the condo and the first thing I did was get out to go pick her up from her carseat. But someone had beaten me to it.
Trin was already standing in the third row, Cait had her arms protectively around her in a hug. Both were already out of the carseat and booster. KH fumed: WHO took her out!!
Caitlin said in a small voice: I did.
It must have happened about five minutes before we arrived. I guess she could not take it anymore. So she unbelted herself, unbelted Trin and both of them sat/stood in the third row with Cait holding Trin. Trin must have been too tired to even try to get to the front by then.
I could not scold Cait.
So I just held Trin. Her little arms went round my neck and her tear-stained face and sweaty hair pressed against my shoulder, her body still heaving with silent hiccups and sobs. We stayed like this for a long time. Trin's eyes swelled to half their usual size and remained puffy until the next day.
I told KH: No more. The next time, we break the journey when she starts to cry. I don't care how long it takes for us to drive back home. I cannot take another one and a half hours of this kind of crying.
But there were no more tantrums about the carseat. For the rest of the journey, she obediently strapped down and apart from some restless fretful protests, she was quiet for the most part - even on the long journey back to Singapore.
In this power struggle, I guess we won. But it feels like a hollow victory.
KH feels vindicated. See, he said. It worked. Just gotta ignore her and she'll get the message that this is non-negotiable.
But I feel rotten to do this to her, necessary though I know it to be for her safety.
More troubling was the size and expression of her anger - the Car Tantrum would go down in the Chong family history for being a real humdinger of a tantrum. But tantrums are not new to Trin. She has other tantrums and will continue to have them.
We have gotten to the stage where everyone walks on eggshells around her. When we hear the slightest wail, angry scream, one of us will say: What does she want? Quick! Whatever she wants, give it to her!! Like a real tyrant, she has struck fear into all of us and that is not good. We fear the screams, we tense up whenever it happens and the whole atmosphere (in the car, or at home) goes flat immediately.
It is not ideal. The kids have been good-natured so far about indulging her. But this is not the answer. In fact I think it could be detrimental to her and to us in the long run in terms of family dynamics. Honestly I am not sure what to do. Standing up to her is like dropping a lit match in a dry forest!
I suspect its got to do with her poor expressive language - and the fact that she's got a very strong will. None of my other babies were ever like this. The only one who ever surpassed Trin in tantrum intensity is Isaac - and he had autistic tendencies! No, Trin is certainly not autistic. But I worry about the anger and the way she demonstrates this.
She can even get physically violent - no qualms about hitting us, even me. And her violence/tantrums extend even to her night terrors. We have had quite a few episodes when she 'wakes' in the middle of the night, screaming. Her eyes are unseeing but open. She flails her arms about, screams, wails, cries "No! No! No! I don't want! I don't want! There! There! THERE!!!" Then she'll tug at us, pull our clothes, smack us, arch her back and throw herself back on the bed, rolling around, getting up and doing it all over again. No amount of placation helps. Not even an offer of 'nen-nen'. KH tries to carry her and I try as well, but she rejects us, screaming all the way. After about 20min to half an hour of this, she will eventually get tired and take the nen-nen again when offered. So nowadays, when she gets like this in the middle of the night, I just sit and wait it out. No point saying or doing anything. Wait until she gets most of it out of her system, then offer her the nen-nen.
She has an appointment at KKH on the 16 of June for her speech delay issue. So I am definitely going to mention this. Meanwhile we continue to live in fear. :-)
Wednesday, June 04, 2008
Life's guarantees
I was reading posts on AP on cord blood banking, home births and multi-fetal reduction and it came to me that the birth culture today, with the advent of technology and advances in research, now offers us so many more choices and tantalising hints of guarantees of perfection. And yet, is there a price to pay? Are we really better off with so many choices? Can we really play God and get away with it?
Today, we seek perfection. We seek choice. We want to live longer. We want to cure diseases and illnesses that were previously incurable. We want to walk on the moon and live on Mars. What once seemed impossible is no longer improbable.
The knowledge and technology that seems so wonderful, that can tell us so much, give us a window to the womb, allow us choices like never before, is also a double edge sword. New ethical dilemmas are spawned. It’s like Eve bit the apple all over again.
Take IVF for a start. The potential to create life outside the womb is an awesome power, once only the prerogative of the gods, now lies in the hands of humans. We now decide how many embryos to implant, their gender etc. And if the number who survive in the womb are too many, what happens? Terminate one? Two?
And what happens to those embryos not implanted? Those are rich in stem cells too. Are those lives, tiny though they may be, expendable? We are back to the old debate on when life actually starts. Now there is preliminary research into the possibility of 'designer babies' with parents possibly faced with choices of the genetic traits they want to include or avoid in their babies. Where will it end?
Then we have prenatal testing to screen for imperfections and abnormalities, with the option to terminate when we find or suspect an imperfect baby.
No prenatal test guarantees accuracy but yet this has opened the doors to unwanted imperfect babies being terminated. Yet, how many babies have been 'terminated' who were later found to be normal? Or the other way around - how many babies claimed to be 'normal' were later found to have some undetected abnormality? How does this impact the parents? How do parents then see their children?
Prenatal testing never guarantees but always raises doubt. Even if a test declares the baby to be 'perfect' and 'normal', a couple may never be reassured that this is so. Would there always be lingering doubts and fears? And for couples who choose to terminate, how terrible and painful a decision to make. A mother, having felt her baby move at 16 weeks, 20 weeks, and then to make the decision to terminate based on the results of a test, how much grief, anger, suffering, doubt she will go through in the future?
We use ultrasound routinely to look within the womb, in search of signs of imperfections and abnormalities, to identify gender and now, with 3D scans, to help parents 'bond'. We have ultrasounds that tell us the size of the baby and from there, whether a C-sec is recommended or not. But ultrasounds are not always accurate. How many babies have been diagnosed to be ‘big’, recommended for C-sec, only to be discovered to be smaller than diagnosed?
With the ultrasound to determine gender, gender selection via abortion is common in countries like China and India. If that seems extreme, it really isn't. Even within the ordinary settings of a doctor's office where a worried couple sit on tenterhooks waiting for their doctor to give them the news - how anxious they may be, how this colours their view of their pregnancy, their baby.
In labour and birth, we have a whole arsenal of tools, tests and interventions at our disposal to try to ‘minimise risk’ of adverse outcomes.
We have the CTG to try to detect fetal distress to arrest the rate of fetal mortality and morbidity - which at least 8 to 9 different studies have shown not to be effective in doing so but has contributed to a high c-sec rate.
Induction rates are high with figures from the US showing that most pregnancies end now at 39 weeks instead of 40 weeks thanks to inductions and elective C-secs. We do not trust the body to go into labour spontaneously but induce at the mildest of reasons: try the following “my doctor will not be here/is on holiday”, “I am already 2cm dilated, so might as well do this” or “you are due today anyway!”
We put a timeline on labour and then augment it if it seems to lag behind manmade deadlines. We break waterbags, cut episiotomies and freely offer drugs, no longer trusting our bodies to cope with its own signals. We do all this in a bid to turn labour and birth from an unpredictable life event to one which can be 'safer' and more 'controlled' or 'managed'. What used to be an emergency procedure to save the lives of babies and mothers in distress, the C-sec is now used almost routinely for breech births, multiples, big babies, repeat C-secs, for mothers too posh to push or for doctors who prefer the fee and the convenience.
The medical community has the best of intentions. No one faults the intent. It honestly believes that birth and labour are processes fraught with risk and so it earnestly comes up procedures and interventions designed to minimise the uncertainty and the risk of birth. We attempt to 'manage' birth - to make the messy manageable, impassive and clinical. Along the way, home births died a quiet death, midwifery-led care faded into the wallpaper, specialist ob-gyns now manage normal births, hospital births and interventions become the accepted norm.
What we have seen so far is that the outcomes are not distinctly or significantly better. The C-sec rates have gone up, so have inductions, augmentations, operative births. Epidurals are popular. Medical cost has gone up as well. Maternal and fetal mortality and morbidity may have declined (though whether that is due to active medical interventions or better infection control and sanitation/hygiene practices is debatable!) but has maternal well-being improved - particularly if well-being is gauged by emotional yardsticks of satisfaction, fulfillment, self-confidence and empowerment?
With the active management of third stage of labour, comes immediate cord clamping and cutting, we now have the advent of cord blood banking and all its tantalising promises of miracle cures, now and in the future.
A managed third stage is relatively new in human history terms - about the last 50 or 60 years – a mere teensy drop in human history. In these 50 or 60 years, we have opted to hasten the 3rd stage, clamping and cutting the cord immediately at birth. The consequences of this have been established and shown in various studies – lower blood pressure, lower blood volume, poorer oxygen saturation, lower haemoglobin, lower iron stores even in the later months of babyhood and speculatively, brain cell damage due to poorer oxygenation and profusion at birth.
And now, thanks to active management of the 3rd stage, the cord is now considered a 'waste' by-product of birth. Something that for millenia, has fulfilled a vital purpose in kick starting life for the baby, is now considered 'defunct' and a 'waste'. How can that be so? How can so many thousands of years of human history and natural selection be wrong? Why do we underestimate and undermine nature's design?
So some bright spark out there one day put together the idea - stem cells = cord blood. Since this is considered a 'waste' anyway, let's make use of it. Hence the emergence of cord blood banking.
I don't deny that stem cells are potentially useful, but so is the cord blood for the baby. What I find even more worrying is that big business has now entered the picture while complete informed consent has been hidden by the glossy brocade curtains of emotive advertising. Are couples told about how cord blood serves the newborn? Do they know the necessity of cord blood to the baby? Can there be other sources of stem cells? To answer that last question - yes, there are other sources, in the bone marrow for instance. But it is easiest and most convenient to harvest cord blood than to do a bone marrow donation.
So we have prenatal testing to sieve out the imperfect or the unwanted. Then we bank cord blood as 'insurance' against a potential incurable disease in the future. But life holds no guarantees. That perfect child who shows no sign of Downs in the amnio might later develop autism, or ADHD or schizophrenia or bipolar disorder? Who knew?
That child whose cord blood is banked may later end up killed in an accident, a plane crash? Who can tell? What happens to the picture of the 'perfect child' then? Is there such a thing as ‘perfection’?
Yet, as a parent myself, I can understand the impetus - who would not want to save their children? Who would not want the best of them, for them? Who would want them to lead a life of burden? So we try to 'save' them – but is that our role as parents? Or would we be better off accepting what comes and cope as bravely as we can with whatever life throws at us, perhaps developing along the way, an optimism, a faith, a trust that a Higher Power will provide what is best for us and for our children's lives? In doing so, do we then teach our children by example, about resilience and strength.
Everything has its time and place, everything has a season and a reason. Trusting in God, Allah, the Universe. Whatever happened to all that? Life is messy. Birth is messy. The only certainty we have in life is death. So why are we so afraid of this? Why do we fear the uncontrollable? Why do we seek power to manage life and all its unpredictability?
We seek guarantees and promises but life offers us none. The more we try to manage all this, the messier it gets and somewhere somehow, a cosmic cookie cart comes unhinged and cosmic cookies roll all over the place.
If we understand that all we have on earth is a finite time, accept all that has been given to us, the challenges, the dreams, the hopes, the fears and work with all this that we have, why would we fear death or the unknown? And then work so hard to tweak or game the system. No wonder that mankind's obsession with control issues have led to interventions on many levels - from birth to global warming.
What price our quest of guarantees, promises and insurance? There are no umbrellas in life. Best to just play in the rain.
I was reading posts on AP on cord blood banking, home births and multi-fetal reduction and it came to me that the birth culture today, with the advent of technology and advances in research, now offers us so many more choices and tantalising hints of guarantees of perfection. And yet, is there a price to pay? Are we really better off with so many choices? Can we really play God and get away with it?
Today, we seek perfection. We seek choice. We want to live longer. We want to cure diseases and illnesses that were previously incurable. We want to walk on the moon and live on Mars. What once seemed impossible is no longer improbable.
The knowledge and technology that seems so wonderful, that can tell us so much, give us a window to the womb, allow us choices like never before, is also a double edge sword. New ethical dilemmas are spawned. It’s like Eve bit the apple all over again.
Take IVF for a start. The potential to create life outside the womb is an awesome power, once only the prerogative of the gods, now lies in the hands of humans. We now decide how many embryos to implant, their gender etc. And if the number who survive in the womb are too many, what happens? Terminate one? Two?
And what happens to those embryos not implanted? Those are rich in stem cells too. Are those lives, tiny though they may be, expendable? We are back to the old debate on when life actually starts. Now there is preliminary research into the possibility of 'designer babies' with parents possibly faced with choices of the genetic traits they want to include or avoid in their babies. Where will it end?
Then we have prenatal testing to screen for imperfections and abnormalities, with the option to terminate when we find or suspect an imperfect baby.
No prenatal test guarantees accuracy but yet this has opened the doors to unwanted imperfect babies being terminated. Yet, how many babies have been 'terminated' who were later found to be normal? Or the other way around - how many babies claimed to be 'normal' were later found to have some undetected abnormality? How does this impact the parents? How do parents then see their children?
Prenatal testing never guarantees but always raises doubt. Even if a test declares the baby to be 'perfect' and 'normal', a couple may never be reassured that this is so. Would there always be lingering doubts and fears? And for couples who choose to terminate, how terrible and painful a decision to make. A mother, having felt her baby move at 16 weeks, 20 weeks, and then to make the decision to terminate based on the results of a test, how much grief, anger, suffering, doubt she will go through in the future?
We use ultrasound routinely to look within the womb, in search of signs of imperfections and abnormalities, to identify gender and now, with 3D scans, to help parents 'bond'. We have ultrasounds that tell us the size of the baby and from there, whether a C-sec is recommended or not. But ultrasounds are not always accurate. How many babies have been diagnosed to be ‘big’, recommended for C-sec, only to be discovered to be smaller than diagnosed?
With the ultrasound to determine gender, gender selection via abortion is common in countries like China and India. If that seems extreme, it really isn't. Even within the ordinary settings of a doctor's office where a worried couple sit on tenterhooks waiting for their doctor to give them the news - how anxious they may be, how this colours their view of their pregnancy, their baby.
In labour and birth, we have a whole arsenal of tools, tests and interventions at our disposal to try to ‘minimise risk’ of adverse outcomes.
We have the CTG to try to detect fetal distress to arrest the rate of fetal mortality and morbidity - which at least 8 to 9 different studies have shown not to be effective in doing so but has contributed to a high c-sec rate.
Induction rates are high with figures from the US showing that most pregnancies end now at 39 weeks instead of 40 weeks thanks to inductions and elective C-secs. We do not trust the body to go into labour spontaneously but induce at the mildest of reasons: try the following “my doctor will not be here/is on holiday”, “I am already 2cm dilated, so might as well do this” or “you are due today anyway!”
We put a timeline on labour and then augment it if it seems to lag behind manmade deadlines. We break waterbags, cut episiotomies and freely offer drugs, no longer trusting our bodies to cope with its own signals. We do all this in a bid to turn labour and birth from an unpredictable life event to one which can be 'safer' and more 'controlled' or 'managed'. What used to be an emergency procedure to save the lives of babies and mothers in distress, the C-sec is now used almost routinely for breech births, multiples, big babies, repeat C-secs, for mothers too posh to push or for doctors who prefer the fee and the convenience.
The medical community has the best of intentions. No one faults the intent. It honestly believes that birth and labour are processes fraught with risk and so it earnestly comes up procedures and interventions designed to minimise the uncertainty and the risk of birth. We attempt to 'manage' birth - to make the messy manageable, impassive and clinical. Along the way, home births died a quiet death, midwifery-led care faded into the wallpaper, specialist ob-gyns now manage normal births, hospital births and interventions become the accepted norm.
What we have seen so far is that the outcomes are not distinctly or significantly better. The C-sec rates have gone up, so have inductions, augmentations, operative births. Epidurals are popular. Medical cost has gone up as well. Maternal and fetal mortality and morbidity may have declined (though whether that is due to active medical interventions or better infection control and sanitation/hygiene practices is debatable!) but has maternal well-being improved - particularly if well-being is gauged by emotional yardsticks of satisfaction, fulfillment, self-confidence and empowerment?
With the active management of third stage of labour, comes immediate cord clamping and cutting, we now have the advent of cord blood banking and all its tantalising promises of miracle cures, now and in the future.
A managed third stage is relatively new in human history terms - about the last 50 or 60 years – a mere teensy drop in human history. In these 50 or 60 years, we have opted to hasten the 3rd stage, clamping and cutting the cord immediately at birth. The consequences of this have been established and shown in various studies – lower blood pressure, lower blood volume, poorer oxygen saturation, lower haemoglobin, lower iron stores even in the later months of babyhood and speculatively, brain cell damage due to poorer oxygenation and profusion at birth.
And now, thanks to active management of the 3rd stage, the cord is now considered a 'waste' by-product of birth. Something that for millenia, has fulfilled a vital purpose in kick starting life for the baby, is now considered 'defunct' and a 'waste'. How can that be so? How can so many thousands of years of human history and natural selection be wrong? Why do we underestimate and undermine nature's design?
So some bright spark out there one day put together the idea - stem cells = cord blood. Since this is considered a 'waste' anyway, let's make use of it. Hence the emergence of cord blood banking.
I don't deny that stem cells are potentially useful, but so is the cord blood for the baby. What I find even more worrying is that big business has now entered the picture while complete informed consent has been hidden by the glossy brocade curtains of emotive advertising. Are couples told about how cord blood serves the newborn? Do they know the necessity of cord blood to the baby? Can there be other sources of stem cells? To answer that last question - yes, there are other sources, in the bone marrow for instance. But it is easiest and most convenient to harvest cord blood than to do a bone marrow donation.
So we have prenatal testing to sieve out the imperfect or the unwanted. Then we bank cord blood as 'insurance' against a potential incurable disease in the future. But life holds no guarantees. That perfect child who shows no sign of Downs in the amnio might later develop autism, or ADHD or schizophrenia or bipolar disorder? Who knew?
That child whose cord blood is banked may later end up killed in an accident, a plane crash? Who can tell? What happens to the picture of the 'perfect child' then? Is there such a thing as ‘perfection’?
Yet, as a parent myself, I can understand the impetus - who would not want to save their children? Who would not want the best of them, for them? Who would want them to lead a life of burden? So we try to 'save' them – but is that our role as parents? Or would we be better off accepting what comes and cope as bravely as we can with whatever life throws at us, perhaps developing along the way, an optimism, a faith, a trust that a Higher Power will provide what is best for us and for our children's lives? In doing so, do we then teach our children by example, about resilience and strength.
Everything has its time and place, everything has a season and a reason. Trusting in God, Allah, the Universe. Whatever happened to all that? Life is messy. Birth is messy. The only certainty we have in life is death. So why are we so afraid of this? Why do we fear the uncontrollable? Why do we seek power to manage life and all its unpredictability?
We seek guarantees and promises but life offers us none. The more we try to manage all this, the messier it gets and somewhere somehow, a cosmic cookie cart comes unhinged and cosmic cookies roll all over the place.
If we understand that all we have on earth is a finite time, accept all that has been given to us, the challenges, the dreams, the hopes, the fears and work with all this that we have, why would we fear death or the unknown? And then work so hard to tweak or game the system. No wonder that mankind's obsession with control issues have led to interventions on many levels - from birth to global warming.
What price our quest of guarantees, promises and insurance? There are no umbrellas in life. Best to just play in the rain.
Subscribe to:
Posts (Atom)