My experience as a medical social work student in the hospice (WK 1-4)

Woah, time flies and I have finally ended my 2.5 months of internship as a MSW in one of the hospices in Singapore. I think it is also a good time now for me to do a little reflection to help me consolidate some of my learning and detail some of my experiences so I will never forget them. 🙂

When I first entered the hospice, being an undergraduate who hasn’t been exposed to the medical setting, it was a completely new experience. I could still remember, on my first day, soon after I arrived for work, I was asked to join in the handover (meeting consisting of the doc, nurses and MSW – update the team on the patients). During the meeting, I felt slightly overwhelmed because, on top of the complexity of each cases, there were also so many medical terms that I had to grapple with.

Lesson Learnt:

  • To be a self-directed learner and google all the medical terms that I don’t understand. 

During the first week, as my supervisor wasn’t around to guide me, I did my readings and spent a bulk of my time in the hospice befriending some of the patients. I was a little fearful at the start because I wasn’t sure if what I say would upset the patients, however, overtime, I realized that most of the patients are actually more than willing to engage and that they always have so many interesting life experiences to share. To be honest, I have learnt so much more from them than from the readings I did.

  • Many times, what is hindering us from saying or doing something is the way we perceive things. If we never clarify or dare to try, we’ll never know how the patient feel. 
  • Most patients are actually open to talking about death, sometimes it is our own fear and anxiety that hold us back. It is always good to reflect. 

In the same week, I also did some house visits with the doctors and nurses. All I can say is WOW I am very impressed by how good the nurses are in handling the patients and their wounds and how professional the doctors are in breaking prognosis. It was also during then that I saw how appreciative many families are towards the medical team, especially the nurses. There was such a strong rapport between the nurses and the family and I wondered what role does a MSW then play if the nurses could do, not just the wound and pain management, but also the psycho-emotional intervention.

  • One thing that distinguishes MSW from the other profession is our knowledge and application of theories in our assessment as well as the soft skills that we have. It is therefore, very important to be well-equipped and strong in our theoretical practice. There is also a constant need for us to build up on our counselling and soft-skills.

In the second week, when my supervisor returned, I visited one of her patient who is in critical condition with her. I don’t think I was prepared for the kind of emotions that overwhelmed me. When I first saw the patient, part of me felt really sad that the person is about to die, another part of me was just really curious about how the patient feels. It was very touching to see how my supervisor constantly reassured the patient to not be afraid (even though the patient could no longer verbalise, but she could still nod her head) and to embrace whatever is to come. Afterwards, my supervisor also started praying with the patient by the bedside as the patient was a Buddhist and she used to pray regularly with my supervisor. The prayers really helped to calm and comfort the patient.

I almost teared up when I saw my supervisor pray with the patient. It is such a privilege to be able to be there for the patients towards the last days of their lives and also to be able to develop such a close and intimate relationship with them. Compared to my previous experience in an FSC, spirituality and religion is such a HUGEE part of palliative care. Many times, it is not just about the physical pain, but also the psychological, social and spiritual pain. Towards the end-of-life, medicine cannot treat, but the positive social rls and having a religion really provides some comfort

In the next few weeks, I got to tag along with different MSWs for their sessions and intake. It enhances my learning by allowing me to pick up the good things the respective MSW did during session. However, it also allowed me to see what are the kind of questioning techniques etc that I won’t ever want to pick up.

Through my observation, one thing that is rather common in the work of a hospice MSW is having to handle strong emotions of the patients and the family.

To cry with the patient& family? Or to not cry with them?

At first, I find myself restricting myself from crying. Then I started wondering, why? Why is it that I can’t allow myself to cry? Personally, I am someone who express myself very freely and I cry often because I find it very therapeutic for me. It was sometimes, really difficult for me to keep my tears in when I feel so much for the patient and their family.  Over time, I realized that it is important for medical personnel like us, to figure out and understand, “what is the meaning behind our tears?”. Are we crying for ourselves? For our own state/fear? Or are we crying because we truly empathize? Having the ability to feel can sometimes allow us to better connect with the patient/family that is grieving and allow us to build better rapport and trust. To me, it is okay to show the family the vulnerable side of us, because after all, we are humans too.

As my hospice was undergoing some renovation and I did not have much cases to do, I went around befriending some patients. I was so glad to have met this old, wise aunty who was always very enthusiastic to talk/play chess with me. She taught me a lot about life, her values and her beliefs. She gave me advice and sometimes even offered me food. There was once when I shook hands with her. She felt that my hands were cold so she wrapped my hands up in hers so she could warm me up. I only got to know her for a month or so before she eventually passed on.

It was the first time in my internship that I have felt such deep connection with a patient. When I went in to the lying in room to see her lifeless body, I really couldn’t help but tear up. My supervisor stood by me as I let all my emotions out. Part of me is grieving over the loss of such a great person, but another part of me is just glad that her suffering has come to an end.

— TBC —


Blindly Helping

“the road to hell is paved with good intention”

This quote just resonates so well with me. I’m not sure how others perceive this, but to me, it means that sometimes, in our attempt to “help”, it actually leads to unintended consequences and sometimes, even harm.

In this modern world, we are constantly bombarded by events and situations around us or even around the world that prompt us to help. When we see an old lady crossing the road, we get that impulse to go over and quickly help the old lady. When we see an aunty/uncle on a wheelchair trying to get around places, we rushed over to lend a helping hand. When we see news articles about people from other countries suffering from poverty/malaria/civil war, it triggers our amygdala and emotions of empathy and sympathy – also an urge to be there to help. However, I wonder if people have truly thought about the consequence of their help and if it is even truly, helpful?

Let us just take some moments, slow down our innate mechanism and drive to help and think.

Just imagine yourself, suffering from some chronic disability/financial/ difficulties etc for a long period of time, and one day, an ‘angel’ descended upon you and offered you help with your difficulties. It would be great if the help can lift us out of the sufferings that we are going through, and allow us to resume our independence in our daily live, however, what happens if the help is only brief and temporary? While it is sad to admit, but this is the nature of help in modern society. Many of the assistance that are provided are brief and temporary without consideration of the longer term impact.

We are so blinded and so eager to help we often don’t consider what kind of impact these acts have on people. In another case, just imagine a family of 4, getting by with little income. Common sense tells us that we should provide this family with financial assistance (usually temporary), but what does it mean to the family? Considering that the family have been able to survive without the additional assistance, injecting this amount of financial assistance would mean that we are disrupting the equilibrium or the natural coping mechanism of the family and possibly creating the problem of reliance. And what happens when we choose to stop the financial assistance? The family needs to find ways again, to cope with this lack of assistance. (FYI, I am not arguing for the cases where the family have problems coping with basic needs, and also families that sometimes just need this additional funding to cope with the temporary crisis).

I personally think that it is important that more people learn to understand the impact of their actions before they do anything, even helping. Consider whether it takes away the element of independence and personal empowerment when we decided to come into the picture and offer help and also what other sustainable ways are available when we help. I don’t think that helping is bad, but helping without conscious thoughts is.

All in all, the act of goodwill / help is just overrated in today’s world. People really need to stop, and think of what is the best way to help (if it even exist). Many a times, the needs of a person or a society stems from a larger system and maybe, it would have been more sustainable if we could involve more systems/organisation and listen to the person (whom we think is needy) to allow for a more personalized and sustainable help. (But yes, of course if it is a case of crisis, then direct help should be rendered.)

To end off,  i would like to share this quote as i like how it encapsulates what i think help should look like: “Give a Man a Fish, and You Feed Him for a Day. Teach a Man To Fish, and You Feed Him for a Lifetime.”


Late night thoughts

Hi there,

It’s been a long time since I have posted anything.

Ended all my papers last week and I have survived Y3S1. Yayyy 🙂

Just when i thought it was time to enjoy hols, so many things and problems started rolling in and I haven’t really been able to rest well even though my exams have ended. It has been tiring to try to keep things going, and i find myself constantly thinking about those problems, finding it difficult to keep my mind free and empty.

Every time i think about the relationship problems i face IRL, it always reminds me of the things i learn in psychology class about humans and the things i learn in social work about how to build relationship. Everything suddenly seem so relevant to me and it is as though i find myself as the client that i always read on the vignettes. Seeing myself as the client, i then start asking my social work self, how would you deal with this if you were a social worker, then there i go, listing out a whole list of possible actions that i could take. As a social work student, i expect myself to at least know about problem solving  (esp when it comes to relationship) better than my friends/family who are not social work students.

However, looking at the list of possible actions that i could try, i find myself being very hesitant and ambivalent about taking those actions. even something as simple as saying sorry can be difficult. These things, i never realized until i myself got stuck in similar situation. Often, i find it easy to come up with actions  to problem solve, but sometimes, it is really difficult to execute it. While those action may seem seemingly easy, it can actually trigger a lot of ambivalence in the client and i am experiencing it now.

It is hard to proceed, but okay, one step at a time. Hopefully things gets better.


Disturbing truth of the Reserved Seating in Public Transport

I travel to school everyday via the train and there’s something that I feels really disturbing to me – the reserved seating.

In Singapore, public transport such as the public buses and train have seats reserved for those who needs it more (e.g. Elderly, pregnant women, or those who are injured) . Usually there will be labels placed near the seats either or, the seats will have striking colors (e.g red) to label the seat as a reserved seating.

I do understand the rationale for such arrangement. It helps commuters be more aware and to give up their seats when they see someone who needs it more. However, in my opinion, while this helps needy people get a seat, it defeats the purpose of building a more gracious country.

What I have observed so far is that, there is great pressure on the people who are sitting on the reserved seat. It seems as though the responsibility of giving up one’s seat lies only in the people taking up the reserved seating. Personally, it gets very disturbing for me whenever, e.g. an elderly come on board, and the commuters NOT sitting on the reserved seating avoid looking at the elderly. Instead they stare at the person on the reserved seating, it was as though they were communicating to the person that, ‘hey you, yes, you are responsible for giving up your seat…’

This is definitely not how graciousness looks like to me. Even though such thoughts are  not verbalize, it is just like a kind of norm that I have observed on the train. I think this has also led many people to avoid the reserved seating, with the fear of being stared at, and also be labelled as an ungracious commuter.

Another reason why I feel that this reserve seating is quite negative (in some sense) is because it kind of promotes some kind of discrimination. It make it seems as though the old people, the pregnant, those with disability are very needy. In a way, it is actually a label that say (in the case of elderly), ‘this aunty/uncle is old and is weak, so please give up your seat to them’.

In addition, this has also led to some of the older adults feeling that they have a sense of entitlement to the seats in public transport. I have observed how older adults naturally walk towards the reserved seating, without saying anything, they just stare at that person, as though they were sitting on their seat.

In any case, I don’t feel like this is a very nice culture in Singapore (Or any other countries). I believe that people are nice by nature, or if not, can be taught to be more caring/ gracious, and that the needy people can also be courteous enough and to learn to ask for a seat on public transport.

It does not take much on us to be aware of the needs of the people around us.

It does not take up too much on us to do something nice for someone else.

Oh well, I guess Singapore still has a long way to go to becoming a more gracious society.

Seeking solace in myself

Yesterday was such a bad and stressful day I cried myself to sleep. I would say crying is actually really theraupeutic because I tend to reenact scenarios in my head and I become more aware of the reasons why I was crying.
Tears are good analysis of emotions and overtime you will find a pattern, realizing how you keep crying over the same things. 

One thing that upsets me the most is probably the feeling of inferiority and feeling leftout, so I probably have to work on getting myself out of such scenarios and adopting better coping methods when in face of such situations in future.

Also, I realized, one reason why I am constantly getting attached to others may be my way of seeking attention to myself. And it’s never healthy to build one’s sense of self-worth based on other’s approval or disapproval 😦

Lastly, while yesterday was a sad day, there’s still much to be thankful for. I’m really touched when my mum made me herbal tea because she knew i wasn’t feeling very well and im grateful to my friends for cheering me up. 

There’s probably much more to life than just studies, stress and work. Keep going~

I’ll be fine

For the 101th time, I need myself to trust that I will be fine and EVERYTHING will be OKAY.

It’s not that I am in denial, but saving myself from potential self-destruction is more important than anything.

Trust that you will be fine.

Have faith in that your efforts will be rewarded.

And even if you are not okay, everything will fall into place in the end.

Just go at your own pace.

In the end,

You will do fine.

You will be okay. 

You will be okay.

You will be okay. 

Monday realisation

Just realized how far I am lagging behind my peers during our group study today. This is perhaps a sign to me that, I should  work really really hard, and I should just study alone. I also realized how I don’t fit at all in the university community. Not only am I not intellectual enough, I am not open and daring enough to ask for help. No one understands how awful this feels. 

Rather than having a bunch of smart friends, I think I will stick to my small space and my own bubble. This is too much for me to handle. I don’t want to try because I am to cowardy for new experience and my heart can’t take it. For every step that I take forward, I go backwards by another 5 steps. Let me just retreat into my comfort zone. And cry.

Feeling super stressed out and I am screaming internally so no one could hear. Sometimes I really wish I could be a more rational and less emotional person so that I would feel less and perhaps devote more energy to get things done more productively.

There’s so much to work on. Right now, let me just be immune to all that’s coming to me and just get my work done.