When people ask me what I do, my new answer is: I'm a research assistant for the Lien Centre for Palliative Care, which is part of the Graduate Medical School run by the partnership of Duke and the National University of Singapore.
Totally self-explanatory, right?
Ok, if you're not complete up with the lingo, rest assured you're not alone. I admit I wasn't completely clear on what Palliative Care entailed when I took the job either. BUT I've learned a lot in the last 4 months and it is really interesting to be gaining experience in this field and to be working with some really distinguished colleagues. Palliative care it is a very important area of growth in the medicine, both in Asia and worldwide. The Lien Centre is focused on education and research, using study findings to inform policy regarding end of life care in Singapore. So this job fits in nicely with my goal of being involved in research that can affect policy to improve the lives of vulnerable populations. In this respect, it is not very different than my former position at CGR.
SO, what is Palliative Care? While generally associated with hospice care, often for cancer patients, that's only part of it. It's a squares and rectangles thing - Hospice Care is generally Palliative, but not all Palliative Care is Hospice Care. And it isn't just for cancer patients (anymore).
Straight from the WHO's mouth:
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
In a Singaporean context, palliative care is of growing importance due to several factors. First of all, Singapore has a 'rapidly aging' population. No, individual citizens are aging at an increased rate. But because of a low birthrate along side increasing life-expectancy, the population over the age of 65 is a growing proportion of the total population. In other words, more and more people are going to be dealing with life-limiting illnesses such as cancer, heart failure, organ failure, and COPD. Which also means families will be dealing with this as well.
Palliative care is also an important concept in Singapore in light of the many different cultures and family structures. The attributes that make up a good life - and a good death - may differ widely from culture to culture, and person to person. Recent research done by the Lien Centre has focused on examining people's preferences for care and lifestyle at the end of life (EOL). Currently, I am helping input data from a survey being conducted with Stage 4 cancer patients and their caregivers - ascertaining not only the patients' preferences, but also the caregivers' preferences for the patient. It should be really interesting to see to what degree patients and caregivers agree on the course of care for the patient! Some of the questions deal with whether or not a patient would be willing to undergo difficult, costly, or painful procedures in order to live longer.
At the heart of this issue is the balancing of length of life versus quality of life. Is it better to undergo painful surgery and miserable side effects in order to live an additional 8 months, or to forego the surgery and only have 4 months that may be less panful? What if the surgery could extend your life by a year? Or 2? At what point do the scales tip? Well, that completely depends on the patient - and their family.
My supervisor and I are currently developing 2 surveys - one to be fielded among cancer patients of all stages, and one to be fielded among physicians. The cancer patient survey examines patients' attitudes towards various situations in which they would forego life-extending treatment in exchange for less pain or lower costs. If this sounds somewhat abrasive, I'd like to assure you that we carefully consider how best to approach these questions in a way that is as sensitive as possible. We are also trying to understand the patients' own understanding of their prognosis, treatment, and risk of recurrence, as well as their information needs and how their cancer diagnosis relates to their participation in the labor force. Right now we are working on getting the survey into IRB for the ethics review, but I am very excited to start fielding it and seeing how people react and respond to the survey.
The physician survey will be looking at physicians' practices in recommending various forms of life-extending treatment. We will also be asking about which aspects of their job they view as most important when treating patients at the end of life - is their most important role to treat pain? Prolong life? Address psychological concerns? Assure the highest quality of life possible? Pretty interesting questions.
As I spend time reviewing literature and discussing issues with my coworkers, I have been running into the question, 'what is a good death,' which is a really daunting question. But when I can start to put aside the gut-level reaction of fear, it becomes an interesting question to consider. I won't say it is necessarily pleasant to contemplate, but I also think that it can lead to a clearer sense of what you would want for yourself and how that might influence choices in the future.
Of course, preferences expressed at one time - say while you're in good health - could drastically alter if you are put in the position of actually making such decisions. Which is why studying the persistence of preferences over time will also be important to palliative care in the future.
Thanks for reading! The next blog will hopefully be a bit more light-hearted.
Saturday, January 26, 2013
Wednesday, January 23, 2013
Indian Food is our New Mexican Food
When Jacob and I were doing the YAGM program in Sabah and South Africa, we both had major Mexican food cravings and despaired at the lack of options. In Rochester, we made up for lost time by honing our salsa- and tortilla-making skills, along with perfecting a pretty wicked refried bean recipe (the secret is Crisco, and lots of it!). We made frequent trips to Chipotle. Soon just visiting wasn't enough, and Jacob took a job at Chipotle for a few months after grad school (1 free burrito per shift!). Authentically 'Mexican' or Tex-Mex, basically, yeah, we love it all: burritos, tacos, quesadillas, enchiladas, guac&chips, empanadas, flautas, huevos rancheros, tamales, nachos, tostadas, and taco salads (you can eat those deep-fried crunchy bowls!). And churros. And cervezas. All sprinkled - our smothered, if you're Jacob - with Tabasco, Cholula*, Frank's RedHot, or perhaps something even more sinister.
But in Singapore, we again face limited options for getting our Mexifood Fix. Fortunately, Tabasco is readily available, but the other ingredients are either hard to find or afford - cheese, as I've mentioned, is very expensive, and beans are maybe even worse! A small can of black beans - maybe $.65 in the States - can easily cost $3.50 here. WHAT? And dry pintos or black beans continue to elude us, so we we brought back 4lbs of pintos from the States after Christmas. I still make a mean salsa (sometimes I kick it up a notch with mango or star fruit), but even plain tortilla chips are a bit hard to run across.
BUT it is okay. We have been able to sublimate at least part of our Mexifood desire by indulging often and heavily in Indian food.
Ohmigod it is so gooooood.
And it seems there are many similarities between the two cuisines. Both seem to take many of the same ingredients and recombine them in different permutations to yield dozens of different foods. There are many different types of flatbreads. Sauces are crucial. Rice is also crucial. And whether it contains meat or just veggies, you'll roll away happy.
I want to add a caveat - I am not an expert! And also, there are like a thousand different ways to make the following foods. And I hope my lovely Indian coworkers will not find too many errors.
The Breads (aka "Sauce Vehicles")
- Prata (Roti Prata) - Oooooooh so good, and especially popular in Singapore. The buttery dough is stretched sort of like a pizza dough, with the maker flipping it around and around until it is tissue-thin. Then he plops it on a well-oiled griddle/stove/hot surface and folds it onto itself creating delicious, thin layers. The end result it is both crispy and chewy, buttery and awesome. Really great dipped in the gravy part of your curry or the dal (lentil) sauce/soup. There is a restaurant by our apartment called 'Prata Planet' which takes prata to a new level, offering all sort of fillings (cheese, eggs, onions, pineapple, meat) and even branching out into dessert prata (try chocolate sauce and bananas with a scoop of ice cream and sprinkles...heck yes.) You can also buy pretty decent frozen prata that go straight from freezer to frying pan.
- Chapati - You may be more familiar with this one. This is a somewhat drier, tortilla-like bread made from whole wheat or Atta flour. Great as a way to pick up meat or veg, scoop up sauce, or just smother with butter (or better, ghee) and garlic.
- Naan - Naan is probably most similar to pita bread. It is thicker than prata or chapati, and is often cooked in a tandoor, a cylindrical clay (or metal?) oven. Our favorite naan is from a hawker in Little India. He has basically an upright oil drum-turned-oven, and after he flattens the dough, he slaps it up against the sides of the drum to cook. He is super generous with the chunks of garlic and/or cheese and actually, I'm starting to realize that I haven't been there in a while...I'll be back in a bit...
- Dosai/Thosai/Dosa - Dosai or Dosa is a paper-thin sort of crepe-like flat bread, only maybe crispier than crepes. It is made from fermented rice batter and black lentils, making it (as I just learned from wikipedia) way healthier than the other alternatives listed here. Gluten- and fat-free, with extra vitamins from the fermentation. Although great for dipping, it is a bit plain all on its own. The batter is poured onto a griddle and spread thinly. Once it browns, it is flipped and then finished almost instantly. They can be made in huge sizes and are generally rolled up or folded when served.
- Papadum - A crispy, almost cracker-like bread, it is often served as a snack or appetizer. They can be roasted, fried, or sun-dried (?) and come in lots of varieties.
As you can tell from the amount of space I dedicated to prata, it is definitely my favorite. Naan is a close second.
Wow...I was going to get into curry and briyani and dal as well, but this blog is already super long! I will leave you, instead, with a description of murtabak, another favorite meal.
Basically, murtabak is a stuffed, savory pancake. The hawker across the street from us uses prata dough, making an extra large pancake. It is then filled with some sort of meat - mutton is especially good - along with onions, egg (added raw so it cooks in the pancake), garlic and sometimes cheese. Dipped in curry and eaten with cucumber slices and tomato or chili sauce.
Wait...that sounds like an Indian calzone! Wait...is the entire premise of my blog incorrect? Is Indian food really like Italian food? Are prata and naan more like Indian pizza? Excuse, I have more 'research' to do...nom nom nom.
*Spell-checker suggests I replace "Cholula" with "Cholera" and "Tostadas" with "Asbestos." No thanks, spell-checker, I like my food epidemic- and mesothelioma-free!
But in Singapore, we again face limited options for getting our Mexifood Fix. Fortunately, Tabasco is readily available, but the other ingredients are either hard to find or afford - cheese, as I've mentioned, is very expensive, and beans are maybe even worse! A small can of black beans - maybe $.65 in the States - can easily cost $3.50 here. WHAT? And dry pintos or black beans continue to elude us, so we we brought back 4lbs of pintos from the States after Christmas. I still make a mean salsa (sometimes I kick it up a notch with mango or star fruit), but even plain tortilla chips are a bit hard to run across.
BUT it is okay. We have been able to sublimate at least part of our Mexifood desire by indulging often and heavily in Indian food.
Ohmigod it is so gooooood.
And it seems there are many similarities between the two cuisines. Both seem to take many of the same ingredients and recombine them in different permutations to yield dozens of different foods. There are many different types of flatbreads. Sauces are crucial. Rice is also crucial. And whether it contains meat or just veggies, you'll roll away happy.
I want to add a caveat - I am not an expert! And also, there are like a thousand different ways to make the following foods. And I hope my lovely Indian coworkers will not find too many errors.
The Breads (aka "Sauce Vehicles")
 |
| Roti prata |
 |
| Chapti |
 |
| Naan - specifically garlic naan! |
- Naan - Naan is probably most similar to pita bread. It is thicker than prata or chapati, and is often cooked in a tandoor, a cylindrical clay (or metal?) oven. Our favorite naan is from a hawker in Little India. He has basically an upright oil drum-turned-oven, and after he flattens the dough, he slaps it up against the sides of the drum to cook. He is super generous with the chunks of garlic and/or cheese and actually, I'm starting to realize that I haven't been there in a while...I'll be back in a bit...
 |
| Dosai |
 |
| Papadum |
As you can tell from the amount of space I dedicated to prata, it is definitely my favorite. Naan is a close second.
Wow...I was going to get into curry and briyani and dal as well, but this blog is already super long! I will leave you, instead, with a description of murtabak, another favorite meal.
 |
| Murtabak. The goodness is trapped inside! QUICK! Get it out!!! |
Wait...that sounds like an Indian calzone! Wait...is the entire premise of my blog incorrect? Is Indian food really like Italian food? Are prata and naan more like Indian pizza? Excuse, I have more 'research' to do...nom nom nom.
*Spell-checker suggests I replace "Cholula" with "Cholera" and "Tostadas" with "Asbestos." No thanks, spell-checker, I like my food epidemic- and mesothelioma-free!
Saturday, January 19, 2013
A Christmas Surprise!
Welcome to 2013! And apologies for the hiatus (because I know you sit by your computer, refreshing and telling yourself, 'today is the day she'll post, I know it, I know it!')
I feel qualified to welcome you to each and every new day, because I am in the future. Or at least, I'm 14 hours ahead, which always leads to lots of extra words when trying to make a skype date - 'my 10pm/your 8am,' etc. Time is a tricky little thing. We've been experiencing that firsthand, as both Jacob and I battled jetlag for a good week after arriving back in Singapore. But the jetlag was well worth it, because we got to spend the holidays at our homes! Which is not where we were expected to be.
Turns out, we are also tricky things.
In October, my dad started the scheme, proposing that we magically appear on my mom's doorstep a few days before Christmas. Though we contemplated whether it was 'too soon' to visit home again, we ended up realizing that it really is never 'too soon' to visit loved ones, especially if it also means getting to take part in holiday traditions and, best of all, if you get to be sneaky doing it!
Unfortunately, it is not possible to just 'magically' appear. It takes a lot of hours and money. We logged the hours ourselves, and for the second part - let's just say this was probably the biggest Christmas present we've ever received (or ever will receive!!). And let's also say THANK YOU, Mom & Dad! We booked tickets in October, then spent the next 2 months making secret plans, trying to keep from spilling the beans, and making fake plans to feed to our unsuspecting families! We enlisted the help of Erich, our brother in law, and Jacob's Aunt Kim, who kept us appraised of the situation in MN, while my Dad prepared for our arrival in Barrington. And yeah, there were code names involved.
As we entered December, we realized that we would need a fake vacation plan, as our families might get suspicious if we (who are so excited to travel) didn't make any plans for the holidays. So our fake trip to Laos was born - complete with itinerary and tour company. In fact, I did so much research that I see a trip to Laos in our future!
On December 22 we headed to the airport and what followed was 34 hours of travel haze. Four hours to Hong Kong, then a 12 hour layover in the (cold!) airport where they continuously played the same hour of bad christmas carols, then the 14+ hour beast of a plane ride to Chicago. Actually, we flew Cathay Pacific airlines and were so impressed - great movie selection, delicious food, ice cream and free beer/wine!* (I not-so-secretly love these long flights - alternating, guilt-free movie and nap binges!) We landed around noon on December 23rd and were met by Agent Boris bearing fleeces and santa hats. On the car ride to Barrington we festooned ourselves in garlands, bows, and huge gift tags. Upon arrival, we jumped out along the driveway and waited while my Dad went in to where my family (Handleys included) was gathered to receive the mystery gift. My dad gave my mom a package that, when opened, revealed the stockings she had made Jacob and I - that she knew we'd taken to Singapore with us. This is what happened next...
It's a bit fuzzy (I'll work on it) so here are some stills:
It was so joyful and relaxing to be home! I love my family's traditions - and Christmas cookies - and learned to embrace some new activities too, like hanging out in the hot tub while there is snow of the ground! And of course, we got in a lot of play time with Matias, Violet & Beatrice (who is now toddling all over). Having young kids around again makes Christmas even more exciting and special. And you know what? Santa didn't even miss a beat - he knew we'd come to Barrington and on Christmas morning our stockings were heavy with candy and gifts! (He got me Sharpies - he just GETS me!)
Meanwhile, the Dalagers still did not know we were in the country. On Christmas day we skyped their cell phone and pretended to be calling them from Laos. We told them that the trip was nice, a bit rainy and mosquito-y but beautiful as well, but that we missed them. We even put on ambient jungle sounds in the background to make the illusion complete. Much credit to Aunt Kim, who was with Holly & Karl during this phone call and managed to keep a straight face (or at least escape to the kitchen before laughing).
On the 27th, we headed up to Hudson, WI, where Erich had arranged for the Dalagers to come to the Lippert's house for dinner. Arriving before them, Erich helped us hide behind the garage, then ushered Anna, Holly and Karl around the back to give Anna the 'surprise' he'd been planning. And, well, this is what followed:
We spent the next five days between Minneapolis and Austin, eating lots of food, playing games, cross country skiing, hanging out with the Dalager's two Chinese foreign exchange students and seeing friends and family! We even had Fon-deux (Fondue x2) - a Dalager Christmas eve tradition that was worth repeating! On New Years Day we had an afternoon reunion with the Swaningsons (Holly's sisters), followed by dinner with a Dalager reunion at the Buucks, including Steve & Sherry and Maia who drove down from Duluth! It was so wonderful to be surrounded by family.
We returned to Barrington for a few more days, celebrating my brother's birthday, seeing my grandparents and the Hanraths, and having an awesome game night at the Handley's. On January 5th, we packed up our suitcases (including an extra one in which we packed our good kitchen knives - we've missed them!), soaked up the last cold and snow we'll see for awhile, and headed to the airport. Travel haze - and re-living the great moments of the last two weeks - and sleeping to prepare for jumping back into work in the new year.
All around, one of my very favorite Christmas/New Years ever!
Blessing to you in 2013!
*Not a paid endorsement for Cathay Pacific Airlines. But if anyone at Cathay reads this and wants to bump us up to first class next time, I wouldn't say no!!
I feel qualified to welcome you to each and every new day, because I am in the future. Or at least, I'm 14 hours ahead, which always leads to lots of extra words when trying to make a skype date - 'my 10pm/your 8am,' etc. Time is a tricky little thing. We've been experiencing that firsthand, as both Jacob and I battled jetlag for a good week after arriving back in Singapore. But the jetlag was well worth it, because we got to spend the holidays at our homes! Which is not where we were expected to be.
Turns out, we are also tricky things.
In October, my dad started the scheme, proposing that we magically appear on my mom's doorstep a few days before Christmas. Though we contemplated whether it was 'too soon' to visit home again, we ended up realizing that it really is never 'too soon' to visit loved ones, especially if it also means getting to take part in holiday traditions and, best of all, if you get to be sneaky doing it!
Unfortunately, it is not possible to just 'magically' appear. It takes a lot of hours and money. We logged the hours ourselves, and for the second part - let's just say this was probably the biggest Christmas present we've ever received (or ever will receive!!). And let's also say THANK YOU, Mom & Dad! We booked tickets in October, then spent the next 2 months making secret plans, trying to keep from spilling the beans, and making fake plans to feed to our unsuspecting families! We enlisted the help of Erich, our brother in law, and Jacob's Aunt Kim, who kept us appraised of the situation in MN, while my Dad prepared for our arrival in Barrington. And yeah, there were code names involved.
As we entered December, we realized that we would need a fake vacation plan, as our families might get suspicious if we (who are so excited to travel) didn't make any plans for the holidays. So our fake trip to Laos was born - complete with itinerary and tour company. In fact, I did so much research that I see a trip to Laos in our future!
On December 22 we headed to the airport and what followed was 34 hours of travel haze. Four hours to Hong Kong, then a 12 hour layover in the (cold!) airport where they continuously played the same hour of bad christmas carols, then the 14+ hour beast of a plane ride to Chicago. Actually, we flew Cathay Pacific airlines and were so impressed - great movie selection, delicious food, ice cream and free beer/wine!* (I not-so-secretly love these long flights - alternating, guilt-free movie and nap binges!) We landed around noon on December 23rd and were met by Agent Boris bearing fleeces and santa hats. On the car ride to Barrington we festooned ourselves in garlands, bows, and huge gift tags. Upon arrival, we jumped out along the driveway and waited while my Dad went in to where my family (Handleys included) was gathered to receive the mystery gift. My dad gave my mom a package that, when opened, revealed the stockings she had made Jacob and I - that she knew we'd taken to Singapore with us. This is what happened next...
It's a bit fuzzy (I'll work on it) so here are some stills:
 |
| 'What? No...' |
 |
| Really?! |
 |
| !! |
Meanwhile, the Dalagers still did not know we were in the country. On Christmas day we skyped their cell phone and pretended to be calling them from Laos. We told them that the trip was nice, a bit rainy and mosquito-y but beautiful as well, but that we missed them. We even put on ambient jungle sounds in the background to make the illusion complete. Much credit to Aunt Kim, who was with Holly & Karl during this phone call and managed to keep a straight face (or at least escape to the kitchen before laughing).
On the 27th, we headed up to Hudson, WI, where Erich had arranged for the Dalagers to come to the Lippert's house for dinner. Arriving before them, Erich helped us hide behind the garage, then ushered Anna, Holly and Karl around the back to give Anna the 'surprise' he'd been planning. And, well, this is what followed:
We spent the next five days between Minneapolis and Austin, eating lots of food, playing games, cross country skiing, hanging out with the Dalager's two Chinese foreign exchange students and seeing friends and family! We even had Fon-deux (Fondue x2) - a Dalager Christmas eve tradition that was worth repeating! On New Years Day we had an afternoon reunion with the Swaningsons (Holly's sisters), followed by dinner with a Dalager reunion at the Buucks, including Steve & Sherry and Maia who drove down from Duluth! It was so wonderful to be surrounded by family.
 |
| Pablo is NOT amused! |
 |
| Fon-deux! |
 |
| Cross country skiing - the exact opposite of Singapore! |
 |
| Family photo! |
We returned to Barrington for a few more days, celebrating my brother's birthday, seeing my grandparents and the Hanraths, and having an awesome game night at the Handley's. On January 5th, we packed up our suitcases (including an extra one in which we packed our good kitchen knives - we've missed them!), soaked up the last cold and snow we'll see for awhile, and headed to the airport. Travel haze - and re-living the great moments of the last two weeks - and sleeping to prepare for jumping back into work in the new year.
All around, one of my very favorite Christmas/New Years ever!
Blessing to you in 2013!
*Not a paid endorsement for Cathay Pacific Airlines. But if anyone at Cathay reads this and wants to bump us up to first class next time, I wouldn't say no!!
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