The true nature of friendship

Source: The Sunday Times, 3 Jan 2010

Genuine relationships are built on more than mutual goodwill and exchanging of favours

By Lee Wei Ling

I had gone to bed at 7pm on Dec 30 from sheer exhaustion. I woke up at 2am and responded to e-mail on my Blackberry.

I noticed that I had missed two phone calls from two very close friends. It was obviously inappropriate to return the calls at 2am, so I e-mailed to say I'd return the calls during lunch time.

I then went back to sleep and have just woken up at 6am, trying to recall what day of the week it was because that would determine my schedule for the day.

For a moment, I thought it was Friday, New Year's Day. It was only when I went outside to pick up the newspapers that I realised it was only New Year's Eve.

I do not usually place any emphasis on 'special days' - whether it be Christmas, New Year's Day, Chinese New Year or birthdays.

These days are determined by the calendar, but to me they are no different from regular days.

In fact, they often are less pleasant than regular days as I dislike the noise and crowds of special days. I solve that problem by simply staying in my room at home on such days, clearing e-mail and paperwork. This applies even to the reunion dinner on Chinese New Year's Eve.

I am by nature not a sociable person. Indeed, I had become asocial by the time I reached pre-university in school. I do have friends and I have never neglected to help any of them when they needed help.

But for most of my adult life, I have not been willing to spend more time than necessary on conversations and social interactions with my friends. I felt that would be a waste of time - time that could have been better spent reading medical journals, analysing research data, exercising and other 'more important activities'.

It was only since 2001, after repeated bouts of illness, that I learnt that friendship does not just mean mutual goodwill, but also spending time with friends talking about things other than medical research.

Staying for months in hospital makes any friend dropping in to see one a welcome relief, though I was not bored as such as I could work on my laptop. As prisoners know, solitary confinement (even in a hospital) can be terribly punishing on the spirit.

Human beings are social creatures. We are social not just in the trivial sense that we like company, and not just in the obvious sense that we depend on others. We are social in a more elemental way: Simply to exist as normal human beings requires us to interact with other people.

There is a Chinese saying, jun zi zhi jiao dan ru shui

xiao ren zhi jiao tian ru mi. The literal translation is: 'The friendship between two honourable people is as understated as water.'

Many of my English-educated friends have difficulty grasping this concept. They would often exclaim in surprise: 'Surely you have changed the saying. The relationship between two honourable people must surely be as sweet as honey.'

No, I have not reversed the idiom. The friendship between two good honourable people is understated. Each will help the other when help is needed even before a request for help is issued. And when one offers to help, the other would accept without feeling any obligation to return the favour.

The 'friendship' between two petty people, on the other hand, is as cloying as honey. When one offers to help, the other would feel that at some point the favour would have to be returned.

The simplest analogy for this saying is as follows: Between honourable friends, there is no account of how many favours I owe that friend and vice versa. The relationship between petty people, on the other hand, requires an accurate account, since for every favour accepted, a return favour would be expected. As far as I can help it, I avoid such friendships.

I am not in the habit of making New Year resolutions. We should change our undesirable behaviour and mend our ways as soon as we discover that our behaviour is less than honourable; there is no need to wait for the New Year to resolve to do so.

2009 has given me both suffering and happiness. I expect the same of 2010. But to all readers who feel a New Year represents a new chapter in life, I wish you a Happy New Year, filled with true friendship and good deeds. And may 2010 be a better year than 2009.



Doing what's right without fear or favour

Source: The Straits Times, 30 July 2008

I WAS born and bred in Singapore. This is my home, to which I am tied by family and friends. Yet many Singaporeans find me eccentric, though most are too polite to verbalise it. I only realised how eccentric I am when one friend pointed out to me why I could not use my own yardstick to judge others.

I dislike intensely the elitist attitude of some in our upper socio-economic class. I have been accused of reverse snobbery because I tend to avoid the wealthy who flaunt their wealth ostentatiously or do not help the less fortunate members of our society.

I treat all people I meet as equals, be it a truck driver friend or a patient and friend who belongs to the richest family in Singapore.

I appraise people not by their usefulness to me but by their character. I favour those with integrity, compassion and courage. I feel too many among us place inordinate emphasis on academic performance, job status, appearance and presentation.

I am a doctor and director of the smallest public sector hospital in Singapore, the National Neuroscience Institute (NNI). I have 300 staff, of whom 100 are doctors. I emphasise to my doctors that they must do their best for every patient regardless of paying status. I also appraise my doctors on how well they care for our patients, not by how much money they bring in for NNI.

My doctors know I have friends who are likely to come in as subsidised patients. I warn them that if I find them not treating any subsidised patient well, their appraisal - and hence bonus and annual salary increments - would be negatively affected. My doctors know I will do as I say.

I remind them that the purpose of our existence and the measure of our success is how well we care for all our patients - and that this is the morally correct way to behave and should be the reason why we are doctors. In NNI, almost all patients are given the best possible treatment regardless of their paying status.

My preference for egalitarianism extends to how I interact with my staff. I am director because the organisation needs a reporting structure. But my staff are encouraged to speak out when they disagree with me. This tends to be a rarity in several institutions in Singapore. The fear that one's career path may be negatively affected is what prevents many people from speaking out.

This reflects poorly on leadership. In many organisations, superiors do not like to be contradicted by those who work under them. Intellectual arrogance is a deplorable attitude.

'Listen to others, even the dull and ignorant; they too have their story,' the Desiderata tells us. It is advice we should all heed - especially leaders, especially doctors.

I speak out when I see something wrong that no one appears to be trying to correct. Not infrequently, I try to right the wrong. In doing so, I have stepped on the sensitive toes of quite a few members of the establishment. As a result, I have been labelled 'anti-establishment'. Less kind comments include: 'She dares to do so because she has a godfather'.

I am indifferent to these untrue criticisms; I report to my conscience; and I would not be able to face myself if I knew that there was a wrong that I could have righted but failed to do so.

I have no protective godfather. My father, Minister Mentor Lee Kuan Yew, would not interfere with any disciplinary measures that might be meted out to me.

And I am not anti-establishment. I am proud of what Singapore has achieved. But I am not a mouthpiece of the government. I am capable of independent thought and I can view problems or issues from a perspective that others may have overlooked.

A few months ago, I gave a talk on medical ethics to students of our Graduate Medical School. They sent me a thank-you card with a message written by each student. One wrote: 'You are a maverick, yet you are certainly not anti-establishment. You obey the moral law.' Another wrote: 'Thank you for sharing your perspective with us and being the voice that not many dare to take.'

It would be better for Singapore's medical fraternity if the young can feel this way about all of us in positions of authority.

After the Sars epidemic in 2003, the Government began to transform Singapore into a vibrant city with arts and cultural festivals, and soon, integrated resorts and night F1. But can we claim to be a civilised first world country if we do not treat all members of our society with equal care and dignity?

There are other first world countries where the disparity between the different socio- economic classes is much more extreme and social snobbery is even worse than in Singapore. But that is no excuse for Singaporeans not to try harder to treat each other with dignity and care.

After all, both the Bible and Confucius tell us not to treat others in a way that we ourselves would not want to be treated. That is a moral precept that many societies accept in theory, but do not carry out in practice.

I wish Singapore could be an exception in this as it has been in many other areas where we have surprised others with our success.

The writer is director of the National Neuroscience Institute. Think-Tank is a weekly column rotated among eight heads of research and tertiary institutions.

PRACTISE WHAT WE PREACH

There are other first world countries where the disparity between the different socio-economic classes is much more extreme and social snobbery is even worse than in Singapore. But that is no excuse for Singaporeans not to try harder to treat each other with dignity and care. After all, both the Bible and Confucius tell us not to treat others in a way that we ourselves would not want to be treated. That is a moral precept that many societies accept in theory, but do not carry out in practice.

Why I choose to remain single

[Updated 23 Oct 2011] In the article "Living a life with no regrets", Dr Lee wrotes that she had never regretted her decision for remaining single: "Better lonely than be trapped in loveless marriage." In that article, she also revealed the health stage of her father Lee Kuan Yew which had gone downhill and recovered since the passing of Mrs. Lee.

Source: The Straits Times, Jan 15, 2010

 

My father became prime minister in 1959, when I was just four years old. Inevitably, most people know me as Lee Kuan Yew’s daughter.

My every move, every word, is scrutinised and sometimes subject to criticism. One friend said I lived in a glass house. After my father’s recent comment on my lack of culinary skills, another observed: “You live in a house without any walls.” Fortunately, I am not easily embarrassed.

As long as my conscience is clear, what other people say of me does not bother me. Indeed, I am open about my life since the more I try to conceal from the public, the wilder the speculation becomes.

My father said of my mother two weeks ago: “My wife was...not a traditional wife. She was educated, a professional woman... We had Ah Mahs, reliable, professional, dependable. (My wife) came back every lunchtime to have lunch with the children.”

Actually, my mother was a traditional wife and mother. She was not traditional only in one respect: She was also a professional woman and, for many years, the family’s main breadwinner.

One of my mother’s proudest possessions is a gold pendant that my father commissioned for her.

He had a calligrapher engrave on the pendant the following characters: “xian qi liang mu” and “nei xian wai de”. The first four characters mean virtuous wife and caring mother.

The second four mean wise in looking after the family, virtuous in behaviour towards the outside world.

My mother lived her life around my father and, while we were young, around her children. I remember my mother protesting gently once about something my father had asked her to do. “It is a partnership, dear,” my father urged.

“But it is not an equal partnership,” my mother replied. The partnership may not have been exactly equal at particular points in time. But over the years, especially after my mother’s health deteriorated after she suffered a stroke, my father was the one who took care of her.

She clearly indicated she preferred my father’s care to that of the doctors’, in itself a revelation of the quality of his care.

He remembers her complicated regime of medications. Because she cannot see on the left side of her visual field, he sits on her left during meals. He prompts her to eat the food on the left side of her plate and picks up whatever food her left hand drops on the table.

I have always admired my father for his dedication to Singapore, his determination to do what is right, his courage in standing up to foreigners who try to tell us how to run our country.

But my father was also the eldest son in a typical Peranakan family. He cannot even crack a soft-boiled egg – such things not being expected of men, especially eldest sons, in Peranakan families.

But when my mother’s health deteriorated, he readily adjusted his lifestyle to accommodate her, took care of her medications and lived his life around her. I knew how much effort it took him to do all this, and I was surprised that he was able to make the effort.

If my parents have such a loving relationship, why then did I decide to remain single? Firstly, my mother set the bar too high for me.

I could not envisage being the kind of wife and mother she had been. Secondly, I am temperamentally similar to my father.

Indeed, he once said to me: “You have all my traits – but to such an exaggerated degree that they become a disadvantage in you.”

When my father made that pendant for my mother, he also commissioned one for me. But the words he chose for me were very different from those he chose for my mother.

On one side of my pendant was engraved “yang jing xu rui”, which means to conserve energy and build up strength. On the other side was engraved “chu lei ba cui”, which means to stand out and excel.

The latter was added just for completion. His main message was in the first phrase, telling me, in effect, not to be so intense about so many things in life.

I knew I could not live my life around a husband; nor would I want a husband to live his life around me. Of course, there are any number of variations in marital relationships between those extremes.

But there is always a need for spouses to change their behaviour or habits to suit each other. I have always been set in my ways and did not fancy changing my behaviour or lifestyle.

I had my first date when I was 21 years old. He was a doctor in the hospital ward I was posted to. We went out to a dinner party. I noted that the other guests were all rich socialites .

I dropped him like a hot potato. In 2005 , while on an African safari with a small group of friends, one of them, Professor C. N. Lee, listed the men who had tried to woo me. There were three besides the first.

Two were converted into friends and another, like the first, was dropped. I am now 54 years old and happily single. In addition to my nuclear family, I have a close circle of friends.

Most of my friends are men. But my reputation is such that their female partners would never consider me a threat. More than 10 years ago, when there was still a slim chance I might have got married, my father told me: “Your mother and I could be selfish and feel happy that you remain single and can look after us in our old age. But you will be lonely.”

I was not convinced. Better one person feeling lonely than two people miserable because they cannot adapt to each other, I figured. I do not regret my choice.

But I want to end with a warning to young men and women: What works for me may not work for others. Many years ago, a young single woman asked me about training in neurology in a top US hospital. I advised her to “grab the opportunity”.

She did and stayed away for eight years. She returned to Singapore in her late 30s and now worries that she may have missed her chance to get married. Fertility in women drops dramatically with age, and older mothers run the risk of having offspring with congenital abnormalities.

Recent studies show also that advanced paternal age is associated with an increased risk of neurodevelopmental disorders in offspring, such as autism and schizophrenia, not to mention dyslexia and a subtle reduction in intelligence.

Men can also suffer from diminished fertility with age although there is wide individual variation.

I would advise young men and women not to delay getting married and having children. I say this not to be politically correct.

I say it in all sincerity because I have enjoyed a happy family life as a daughter and a sister, and I see both my brothers enjoying their own families.

Many important lessons on life come not from textbooks but from real people

Source: The Sunday Times, 21 Dec 2008

In 1983, I was training as a neurology resident at Massachusetts General Hospital, the premier Harvard-affiliated hospital that some termed ‘Man’s Greatest Hospital’.

This was where the rich and powerful came to seek medical treatment. It was where Dr Henry Kissinger, for instance, had the triple heart bypass that saved his life.

I was doing a six-month posting in the neurophysiology laboratory. By sending small electric shocks down nerves and inserting needles into muscles, we could try to figure out the health of the nerve cells supplying various muscles as well as of the muscles themselves.

My patient one morning in summer was a businessman who owned a shoe factory in New Hampshire. He came with a note from his neurologist that said he had ‘progressive bulbar palsy’, a variant of Lou Gehrig’s disease in which the first and dominant symptoms relate to weakness of the muscles of the jaw, face, tongue, pharynx and larynx.


The tests of the nerves and muscles in the rest of his body were fine, and the final test was to put a fine needle in his tongue. I had never done this before, so I asked a senior colleague to supervise me.

The electrical activity picked up by the needle confirmed the dreaded diagnosis. I told the patient that a report would be sent to his neurologist. Then, as he changed from the hospital gown into his street clothing, he asked me where I was from. I replied that I was Dr Lee and that I was from Singapore.

‘You are Lee Kuan Yew’s daughter,’ he said.

I was dumbfounded and asked: ‘How do you know?’

‘I didn’t know,’ he replied. ‘I have heard of Singapore and of Lee Kuan Yew and meant it as a joke. So you are Lee Kuan Yew’s daughter! I am Jo.’

It turned out that Jo’s daughter was considering studying political science at the National University of Singapore (NUS) and was in correspondence with the NUS admissions office.

Jo invited me to his home in rural New Hampshire. I accepted because I intuitively trusted this man, who I knew would soon be told of his death sentence.

During autumn two months later, when New Hampshire’s fall colours would be at their peak of loveliness, he drove down to Boston to pick me up for the four-hour drive to his home.

By now, he knew what he was facing. There was calm acceptance and he was putting his business in order so that his family would be financially secure when he passed on.

His speech was slurred and I had to concentrate to make out what he was saying. He had to make an effort to try to pronounce his words as clearly as he could.

We went hiking on the hills near his home. I won’t even try to describe the magnificent scenery of the autumn foliage. It has been captured on many canvases as well as calendars.

Once, we came upon a paddock where someone probably kept his horse(s) during summers. Jo told me a joke attributed to Ronald Reagan about how two people reacted when they found a paddock empty with only horse dung in it.

The first said: ‘Dammit! The horse has escaped.’ The second said: ‘The horse dung is still wet, the horse must still be close by.’

Jo did not say more than that, but tacitly I knew he was taking the second attitude. He would face his predicament as positively as he could. I respected him for his courage.

The next time he invited me was in winter when we went cross-country skiing. Although his speech was even more slurred on this occasion, his body was still strong and he out-skied me because he was a more experienced skier.

On Sunday morning, the family was going to church and asked me to go along. I did not have any appropriate attire for church, but Jo told me: ‘God does not care how you are dressed.’

So there I was, a scruffy non-believer, attending mass with the Catholic family that I was spending a weekend with. I wondered whether Jo drew his strength from his religion, but speaking was such an effort for him now that I did not ask.

The last time I saw him was when he was admitted for an operation to put a tube through the abdominal wall into his stomach. He could neither speak nor swallow on this occasion. He looked emaciated but he was still alert and cheerful when I visited him.

Soon after, I returned to Singapore after undergoing three years of training in neurology. A few months later, I received a card from Jo’s daughter informing me of her father’s demise.

Many of the most important lessons that I have learnt about life and how to live it have come from my patients. Jo was my first teacher in a subject that cannot be taught through lectures, tutorials and textbooks.

I may have no choice in the misfortunes that life chooses to inflict on me. But I do have a choice in responding to those misfortunes positively or negatively. To a certain degree, my happiness is within my control. That is an easy lesson to preach but difficult to practise.

More than once over the last 25 years, I have been faced with nasty circumstances beyond my control. Twenty-five years on, I am better at accepting adversity and trying my best despite them. I am still trying to do so every day.

Perhaps if this philosophy of life had more believers, we would have less of the whining that Singaporeans are prone to, less misery and a more positive outlook towards all of life’s situations no matter how adverse they may be.

Finally, learning should not be too tightly linked to formal academic institutions. Instead, it is a lifelong process that occurs in all spheres of life. Every encounter, positive or negative, is a possible lesson if we analyse it deeply.

Jo taught me something that ‘Man’s Greatest Hospital’ didn’t.

The day I failed an examination

Source: The Sunday Times, May 3, 2009

In February 1982, I took my MRCP part 2 in Edinburgh. The MRCP exam is the postgraduate examination for internal medicine and paediatrics organised by the College of Physicians in Britain. Three universities conduct the examination simultaneously - London, Glasgow and Edinburgh.

I chose to take my examination in Edinburgh because I was not sure I could understand London's Cockney accent or the Glasgow accent. The Edinburgh accent, I figured, would be much easier for me to understand. I was down with flu at the time of the practical examination in which we were supposed to examine patients.

I was told to listen ('auscultate') to the heart of my first patient. I guessed what she had but could not hear the corresponding heart murmur. From then on, my examiners became unfriendly and I became nervous. When the examination was over, I went back to the hospital where I had examined the patient and asked her mother what was wrong with the patient. I had guessed correctly: She had a mitral stenosis, which causes a murmur that is notoriously difficult to hear.

Nowadays, doctors no longer need to have acute hearing in order to diagnose heart conditions. A cheap and simple ultrasound produces clear anatomical pictures, including of heart functions. No more guessing is required. I was sure I had failed the examination though I had sailed through the written paper and the subsequent viva voce.

When the results were announced, I was in the Royal College of Physicians of Edinburgh building. After the crowd had thinned, I went forward to read the list of names. Mine was not on the list. The news spread like wildfire among the Singaporean medical community. 'Lee Wei Ling has finally failed an exam! She is like any one of us.'

I took my failure very badly because I knew I did not deserve to fail. I did not even need the MRCP as I already had my Master of Medicine (in paediatrics), which is on equal footing with the MRCP. I was also hurt by the fact that many Singapore doctors seemed happy I had failed. I swore to myself that I would not take the examination again. But my father told me: 'You have to take that exam until you pass it. You have to prove to Singapore you can do it.'

My parents have never pressured me or my brothers to aim for academic success. If there was any 'pressure', it was no more than an implicit expectation. This was especially so with me, the most highly strung and stubborn of their three children. I was determined to prove I could equal my brothers' academic achievements.

All my previous examination successes - except for the one doctors need to pass to practise in the United States - had occurred in Singapore. For all written medical examinations, local or foreign, one wrote only one's index number on answer sheets. So there was no question of examiners favouring me because I am Mr Lee Kuan Yew's daughter.

But my father nevertheless wanted me to show Singaporeans that I could succeed outside of Singapore, though success in the MRCP examination is to a small but significant extent dependent on luck.

So I returned to Edinburgh to re-take the MRCP in October 1982. This time I took great care not to catch any bug, and I went up to Edinburgh by train wearing a face mask. Everything went smoothly and I knew I had passed. Indeed, I knew more about the patient - a young child with brain damage - than the examiner.

I returned to London after the examination and asked a friend to telephone me the results. After I received confirmation that I had indeed passed, I phoned home. Ming Yang, my late sister- in-law, picked up the phone. I asked her to tell the rest of my family that I had passed. And I asked about her new baby. She told me he was an albino. Hsien Loong was a little disappointed and had told our father the boy would not be able to do national service. I also knew that albinos have poor eyesight. My heart went out to Ming Yang and Loong.

I flew back to Boston, where I was based then. While napping after my arrival, my father phoned me. 'Ming Yang passed away of a heart attack,' he reported. 'Come back now.' I returned to Singapore for Ming Yang's funeral and stayed to mark the new baby's first month.

My father arranged my return flight to Boston. As he believed flying west was less tiring, I flew through London and stopped there for a day. Since then, London has always brought back unhappy memories for me and I avoided going there until 2004, when I needed to meet someone in Edinburgh.

As luck would have it, his house was but a street away from the Royal College of Physicians of Edinburgh building. After our meeting, I walked right up to the front door of the building. The building was locked since it was a Sunday. I stood there for a few minutes, before turning to another friend who had accompanied me and said: 'Red dust.' (A Chinese expression signifying the illusions of life.)

Twenty-seven years later, my examination failure seems inconsequential. But I have no regrets having tried and failed the first time. It made me appear normal to the Singapore medical community. Also, considering how outspoken and aggressive I can be, a failure that lent me a vulnerable image did me no harm. My failure forced me to learn how to roll with the punches and to react to life's capriciousness with equanimity.

As for my albino nephew, he has grown into a kind, considerate and responsible young man who is not ashamed of being different from the average man in the street. He too has learnt to accept what he cannot change and to adapt his life around the constraints. Life is unpredictable for all of us. But if we persevere and adapt, many apparently impossible difficulties can be overcome. That my nephew will graduate soon from the National University of Singapore is proof of that fact.