SINGAPORE: In a scene from The Two Towers of the Lord of the Rings film trilogy, King Theoden awakes from an enchanted state to realise that his son Theodred has been killed. Responding to attempted words of comfort, he says, “No parent should have to bury their child” before breaking down in grief.

The death of a young person seems to go against the natural order of things. It shouldn’t be. It couldn’t be. Which is why people respond with disbelief, shock, indignation and pain. And which is why in some traditional Chinese societies, a situation where 白发人送黑发人 (literally meaning “a white-haired person sending off a black-haired person”) was considered so inauspicious that an older person might be prevented from attending a younger relative’s funeral.

It is uncommon for younger people to die. According to statistics, in 2015, less than 10 per cent of deaths in Singapore involved residents aged 50 years old and younger. A proportion of these deaths would have been sudden and unexpected, due to an accident, an outbreak of violence or a sudden collapse. In others, it would have followed a period of illness, so some of these deaths were not so “unexpected”. But they are distressing and traumatic all the same.

WHAT MAKES IT SO HARD

In palliative care, the focus of care is not only on the patient, but also on the family and nowhere is this more evident than for the younger patient. Frequently there are three generations involved – for the younger patient, this would be parents and grandparents; for the older-but-still-young patient in the “sandwich generation”, there could be siblings, a partner, young children and elderly parents.

Everyone is affected in different ways and everyone has their own way of dealing with it.

The particular grief of a young person’s passing is poignantly expressed by the Reverend William Sloane Coffin, who in 1983 lost his son Alex in a car accident. He delivered a eulogy to his congregation where he said: “When parents die, as my mother did last month, they take with them a large portion of the past. But when children die, they take away the future as well.”

This is perhaps what makes the pain so profound. Contracting a serious illness such as cancer or a motor neuron disease begins a series of losses for the patient, not just of health, but on a deeper level, of one’s sense of self, hopes and dreams for the future.

What do you do when you know you will never see your children grow up, that you will never grow old, nor “ride off into the sunset” with your life partner?

WHAT MAKES IT MORE BEARABLE?

In palliative care, one must have information about the future in order to plan, prioritise and prepare. Not everyone will want a detailed account of what to expect, but patients and families should have enough information and be able to consider a range of options, whether it is to pursue aggressive and even experimental treatments in order to prolong life as much as possible, or to focus on symptom management only (with quality of life above all else), or somewhere in between.

People do the best they can to cope. Support can come from many sources, from one’s family, friends, faith community as well as healthcare professionals. 

For younger patients, peer support can be particularly important, whether it is friends from school or a sports club or even fellow patients and they may choose to connect face-to-face, or on social media. Associations like CanTeen who support youths in Australia and New Zealand, exist to provide information and support to young people who have cancer or have a loved one living with cancer, whether a parent, sibling or friend.

Every person wants to live as normal a life as possible, even with serious illness, and for younger patients, this means being able to hang out with friends, go to school, and yes, even serving National Service. I have had patients who wanted to take their final examinations despite being very ill and it was touching to see how hard their schools and teachers tried to make that happen for them.

WHAT WE CAN DO BETTER?

The problem is that palliative care tends to be considered very late. This is despite evidence that palliative care can improve one’s quality of life, and may even be life-prolonging for some patients. “It’s not time yet” is an oft-heard remark. The reality is, it may never be the “right” time but it may be the only time for those important discussions.

A recent news report from Australia highlighted that there were still many patients who were not getting palliative care support. New South Wales’ Health Minister Brad Hazzard commented: “We have a whole range of specialists who are trying to keep people alive – and trying to give them a good death comes perhaps as an afterthought.”

These are harsh words, perhaps with a ring of truth, but are more a reflection of the healthcare system.

“Sometimes, doctors don’t have the language to get patients ready for dying. It’s not because the doctor can’t be bothered or because the doctor doesn’t care.”

Healthcare systems everywhere are still geared towards hospitals, treatment and fixing problems, without offering many substantive alternatives to the great “unfixables” like ageing and dying.

Given the chance, many people would want to do more with the time left. Some patients will want to make practical preparations; others may wish to leave mementoes, gifts or letters; yet others will want to tick off items on their bucket list. What they do would be unique and meaningful to that person and family.

Young people can and have made lasting impressions and left legacies for their families and others. Singaporean Jordan Lim was 18 years old when he died from bone cancer but not before deciding to donate his corneas. Kate Granger was a UK geriatrician and cancer patient, who campaigned for better patient care and raised funds for charity. She died last year aged 34.

WHAT THE LIVING CAN LEARN FROM THE DYING

A recent survey conducted by the Kaiser Family Foundation and the Economist across four countries showed remarkable similarities about what people valued towards the end of life. A few wanted their lives to be prolonged as much as possible, but the majority wanted their lives to be comfortable, at peace, with their loved ones around them and not burden their families with financial worries, or having to make decisions for them.

So, young or old, richer or poorer, it turns out the things that matter at the end of life, aren’t “things” at all.

To quote Paul Kalanithi from When Breath Becomes Air, who passed away from lung cancer in 2015:

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladders toward the goals of life, flattens out to a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: A chasing after wind indeed.

As a society, we need to consider how we view “living with dying” if we want to live well before leaving well. The first step is to recognise it could happen to you, or to someone you love. Then be willing to start a conversation about what matters most.

Seriously, it won’t kill you to talk about it.

Dr Noreen Chan heads the Division of Palliative Care at the National University Cancer Institute, Singapore. Dr Chan is also a panelist on Channel NewsAsia’s Perspectives episode on Patients in Pain, which will be broadcast on May 17 at 8pm Singapore/Hong Kong/Manila.

This is the second commentary in Channel NewsAsia’s series exploring key issues and challenges facing patients with terminal illness and care at the end of life.

Read the first commentary on what well-being means for someone with terminal illness here.

SINGAPORE: Approximately 40 flights at Changi Airport were affected on Tuesday (May 16) evening, after a fire at Terminal 2 led to the entire terminal being shut, the airport management said.

The airport terminal received the all-clear from the Singapore Civil Defence Force (SCDF) at about 10.00pm. Since then, operations have resumed progressively beginning with a number of flights arriving at the terminal, Changi Airport Group said in a news release.  

“Changi Airport will do its very best and work through the night to clear the backlog of delayed flights,” the airport management said in a media release late on Tuesday night.

It added that Changi Airport would work with authorities to investigate the incident.

The fire had broken out in a room containing air-conditioning equipment at Terminal 2, the airport said.

It said that, based on its information, two people in the terminal were taken to hospital for observation after approaching airport staff for medical assistance. Another four were taken to a clinic at Terminal 3.

Separately, SCDF earlier said that three people had been taken to hospital for smoke inhalation.

While firefighters from the Airport Emergency Service and SCDF dealt with the fire, Terminal 2 was closed and all flights moved to Terminal 3.

Additional manpower and resources were moved to Terminal 3 to handle the flights, check-in and baggage, and airport staff were also on the ground to help direct passengers, the media release said.

Changi Airport also coordinated with regional airports with flights arriving into Singapore to adjust their departure times to help manage the arrival load, it said.

It added that passengers departing or arriving on Wednesday, May 17, are advised to check Changi Airport’s website, app or social media channels for updates. 

SINGAPORE: After a three-hour flight from Phuket to Singapore, Adelia Bordessa found herself waiting another three hours on the tarmac of Changi Airport’s Terminal 2, where passengers and ground staff alike were evacuated over a fire that broke out in the terminal on Tuesday (May 16) afternoon.

Ms Bordessa said she was on Silkair flight MI753, which arrived at Terminal 2 at around 6:05pm. She told Channel NewsAsia she could smell smoke – though not heavy smoke – upon arrival. “We were directed to immigration on the ground floor at Gate D/E end of Terminal 2 … then escorted to a side door and then onto the tarmac.”

She estimated that there were approximately 1,500 people on the tarmac, and that buses were ferrying passengers to T3 at about 15-minute intervals.

She did not hear any announcements telling passengers when they might get on a bus, she told Channel NewsAsia.

By the time she boarded a bus at 9:15pm, there were still about 80 to 100 people left on the tarmac, she said.

An employee of ground handler SATS, who declined to be named, told Channel NewsAsia that around 6:15pm, staff members and passengers alike were asked to move out of the transit area and onto the tarmac. These included passengers who were waiting to board as well as passengers who were already on board planes.

Passengers on flights that had been scheduled to depart from the terminal were told to expect”significant delays,” airport management said, adding that all Terminal 2 flights had been moved to Terminal 3 until further notice.

M Ramarao, 36, an Indian software engineer working in Singapore, was set to take a flight back home with his 18-month-old daughter when they were evacuated.

“I am very worried now because we have a doctor’s appointment tomorrow morning for my daughter who fractured her arm, so it’s quite urgent,” he told AFP.

“If it’s for one or two hours it’s okay, but they shouldn’t cancel the flight.”

A Russian tourist who identified himself only as Alexander expressed hope his flight to Moscow would not be cancelled.

“They told us that there was smoke at a part of the airport,” he told AFP.

Singapore Airlines said it was “working closely with the airport authority and various agencies to ensure flights can be resumed in the shortest time possible”.

More than 58 million international passengers passed through Changi Airport last year. The airport serves more than 100 airlines flying to some 380 cities worldwide. 

SINGAPORE: About 500 Singapore IPs could thus far have been affected by the WannaCry ransomware attacks that began last Friday and hobbled big organisations in Europe and Asia, said the Cyber Security Agency of Singapore said (CSA) on Tuesday (May 16).

The ransomware locks users’ files and demands that they pay attackers a designated sum in the virtual currency Bitcoin.

However, the affected computers in Singapore may not have had their files encrypted because of the “kill switch” that allowed one researcher to inadvertently limit the spread of the ransomware, said Dan Yock Hau, director of the National Cyber Incident Response Centre, which is a unit of CSA.

“Affected users will still need to patch and clean up their systems,” he said, adding that SingCERT is working with IMDA and internet service providers (ISPs) to inform the potentially affected users.

Mr Dan added that, as of Tuesday afternoon, no critical information infrastructure has been affected.

There were no calls asking for help to recover from the ransomware, CSA said, adding that SingCERT received a small number of calls from businesses and members of the public wanting to find more about ransomware prevention and patching.

CSA said it would continue to monitor the situation closely.

SINGAPORE: Changi Airport Terminal 2 was evacuated on Tuesday (May 16) after a “small fire” broke out at the departure hall, said the Singapore Civil Defence Force (SCDF). 

Three people were taken to hospital for smoke inhalation, it added, and the fire was put out using a hosereel jet.

According to Changi Airport, the fire alarm was activated at about 5.40pm due to “smoke coming through the air vents”. Channel NewsAsia understands the fire started in a storeroom. 

In an update at about 6.45pm, Changi Airport said the situation is under control and the cause of the fire has been identified. It added, however, that flight operations at Terminal 2 are affected, and that passengers should expect “significant delays”.

At about 8.10pm, Changi Airport said the terminal remained closed “in the interest of ensuring safety”. All departing and arriving flights at Terminal 2 were moved to Terminal 3 until further notice and passengers were advised to check the flight information screens in the terminal and the Changi Airport website for flight details. 

People were evacuated onto the tarmac of Terminal 2, including passengers waiting to board, those already on board as well as staff. 

Nearly two hours after the firm alarm went off, people were still waiting outside the terminal. Some passengers who were evacuated told Channel NewsAsia that they were directed to shuttle buses which would take them to Terminal 3 for their flight out.

Earlier, Channel NewsAsia reader Noorazli Noor said his fiancee, who works at the airport, was told to evacuate as the smoke worsened. 

Another Facebook user, Glinise Lorenzo-Singh, told Channel NewsAsia the fire happened at Gate F of the terminal. Her sister-in-law was inside the terminal waiting to board her flight when she was told that the flight would be moved to a different gate, Ms Lorenzo-Singh said. 

Due to the incident, bus services 24, 27 and 53 will skip the bus stop at Terminal 2, said transport operator SBS Transit.

SINGAPORE: Channel NewsAsia recently published an article featuring the move by Nanyang Girls’ High School (NYGH) to a later school start time. As the researchers involved in this initiative, we have been following the response to this article on social media with interest. 

Feedback from the public seems to be largely positive, but there have also been concerns raised about the potential costs of starting school later. Our team is not blind to these challenges and we would like to share why we believe that starting school later is advisable in spite of them.

STUDENTS SHOULD GET APPROPRIATE AMOUNT OF SLEEP

Sleep is important for health and from the responses to the article, it seems that most readers agree with this. However, it has become the accepted norm for students to get insufficient sleep on weekdays and try to catch up on sleep on weekends. A common belief is that these cycles of short weekday and long weekend sleep will average out to a healthy and recommended amount. 

We disagree. Research indicates that sleep is like food: It is needed every day and in appropriate amounts for healthy functioning. Health professionals have recommendations for daily nutritional requirements and many parents do their best to ensure that their children get three balanced meals a day.

We might think it odd to allow children to skip a meal a day on weekdays and then make up for it by eating double the amount on weekends. And yet, this is what we expect of our students when it comes to sleep. We expect that they should be able to function optimally on an imbalanced “diet” of inadequate sleep on school nights and oversleep on weekends.

Some may subscribe to the idea that sleep restriction builds resilience. Again, we could not disagree more. Sleep loss does not confer the same kinds of benefits as exercise, where the mantra goes “no pain no gain”. It is not like willpower or discipline, where the more you train and push your boundaries, the stronger you become. We do not consider starving our children to make them more resilient, or worry that giving them their daily nutritional requirement every day is pampering them. Why should we think differently about sleep?

With their current sleep patterns, our students do get by in school and some may argue: If it isn’t broken, why fix it? However, we believe that students should be flourishing and not merely getting by. Research shows that getting the appropriate amount of sleep not only helps students feel better, but also helps them learn better – a win-win situation.

There are also those who are not genetically predisposed to function well without sleep. These individuals will certainly accomplish more if they are not struggling to stay awake most of the time and if they have better psychological and emotional health.

ADOLESCENTS CAN FIND IT DIFFICULT TO FALL ASLEEP EARLIER

Some have questioned: Instead of starting school later, why not just get students to sleep earlier? The answer to this lies in our circadian biology. The human body is governed by processes that regulate when we fall asleep (or feel sleepy) and when we wake up (or feel alert).

Research has shown that during adolescence, changes occur that gradually push the human body clock back by several hours. This means that while younger children have less trouble falling asleep earlier at night, many adolescents can find it difficult to fall asleep before 11pm.

Think about the last time you had jet lag and were trying to fall asleep when your body was telling you to stay awake. Telling adolescents to go to bed earlier is putting them through a version of that experience every single day.

Starting school later is only one part of the solution to the sleep problem faced by Singapore students. Others, which we are also working toward, include instilling good sleep habits and encouraging proper time management.

However, because of our circadian biology, starting school later remains a cornerstone of that solution.

Even in the ideal situation of good sleep habits, or even reduced workload, as some readers have suggested, most teenagers would still only be able to fall asleep around 11pm. They should therefore only wake up after 7am to get at least eight hours of sleep, which is the minimum recommended sleep duration for their age.

Yet, unless students only take 30 minutes to get ready and make their way to school, there is no way that students can get those eight hours of sleep if school starts at 7.30am.

ADJUSTMENTS AND COMPROMISE NECESSARY TO MAKE LATER SCHOOL START TIMES A REALITY 

Starting school later will come with its challenges. One of the biggest concerns that has been raised is that there will be more traffic congestion because the school crowd will collide with the work crowd.

This is a difficult problem, but not an insurmountable one. Innovative ways to relieve rush-hour congestion already exist and will continue to be developed. For example, Schoolber is a ride-sharing platform that provides carpooling for students.

Adjustments and compromise will be necessary to make later school start times a reality.

The change we envisage will not happen overnight. NYGH spent half a year in preparing to shift their start time. They went through many rounds of revising the curriculum before rolling out one that would allow school to end at around the same time without comprising curriculum coverage. 

They were aware of the potential impact on transport, so they surveyed their students to understand their transport situation and concerns. The school also monitored local traffic conditions before the change to determine how much of a delay would be tolerable.

In short, NYGH spent significant effort to figure out how to delay school start time in the most optimal, least disruptive way.

The results from the experiment were clear: Students were happier, more alert and more positive about going to school. Isn’t this something precious, even if change is hard and will lead to short-term inconvenience?

When facing pushback against her campaign for healthier school cafeteria lunches, Michelle Obama had this to say: “Don’t play with our children. Don’t do it.” We urge teachers, parents and stakeholders to come forward and say the same.

Julian Lim is Assistant Professor at the Centre for Cognitive Neuroscience at Duke-NUS Medical School. Lee Su Mei is a postdoctoral fellow at the same centre.

SINGAPORE: Prime Minister Lee Hsien Loong and Communist Party of China (CPC) Politburo member Zhao Leji on Tuesday (May 16) affirmed the “strong and substantial relationship” between Singapore and China, the Prime Minister’s Office (PMO) said in a statement.

Mr Zhao, who is also Central Organisation Department Minister, is in Singapore to co-chair the 6th Singapore-China Forum on Leadership.

During the meeting, Mr Lee and Mr Zhao affirmed the “strong and substantial relationship” between Singapore and China, PMO said.

The two leaders noted that bilateral relations dated back to 1976, when then-Prime Minister Lee Kuan Yew first visited China, and 1978 when then-PRC Vice Premier Deng Xiaoping visited Singapore. “Mr Lee and Mr Deng provided a strong foundation for the friendship and cooperation that the two countries now enjoy,” PMO noted.

PM Lee and Mr Zhao agreed that, over the last 40 years, bilateral cooperation has evolved greatly, reflecting the development and changing priorities of both countries, the statement said. 

Human resource development has become one important area of cooperation, the PMO statement said, adding that both leaders noted the importance of the Singapore-China leadership forum as a key platform to share experiences in the areas of governance and training of officials.

Mr Zhao also expressed appreciation for Singapore’s participation at the “Belt and Road” Forum, which took place in Beijing from May 14 to 15.

On regional issues, both leaders affirmed the close relations between ASEAN and China, and looked forward to meaningful progress on the Regional Comprehensive Economic Partnership. 

SINGAPORE: Changi Airport Terminal 2 was evacuated on Tuesday (May 16) after a “small fire” broke out at the departure hall, said the Singapore Civil Defence Force (SCDF). 

According to Changi Airport, the fire alarm was activated at about 5.40pm due to “smoke coming through the air vents.”

In an update at about 6.45pm, Changi Airport said the situation is under control and the cause of the fire has been identified. It added, however, that flight operations at Terminal 2 are affected. 

SCDF said the fire has since been put out using a hosereel jet.

“Passengers on flights departing from T2 this evening should expect significant delays,” said Changi Airport. “We will advise when operations resume.”

People were evacuated onto the tarmac of Terminal 2, including passengers waiting to board, those already on board as well as staff. 

Nearly two hours after the firm alarm went off, people were still waiting outside the terminal. Some passengers who were evacuated told Channel NewsAsia that they were directed to shuttle buses which would take them to Terminal 3 for their flight out.

Earlier, Channel NewsAsia reader Noorazli Noor said his fiancee, who works at the airport, was told to evacuate as the smoke worsened. 

Another Facebook user, Glinise Lorenzo-Singh, told Channel NewsAsia the fire happened at Gate F of the terminal. Her sister-in-law was inside the terminal waiting to board her flight when she was told that the flight would be moved to a different gate, Ms Lorenzo-Singh said. 

Due to the incident, bus services 24, 27 and 53 will skip the bus stop at Terminal 2, said transport operator SBS Transit.