Monday, 5 September 2011

How it happened

Calm before the storm

Monday 29 Aug: Played a robust 18-holes at Island (SICC) "Balmy weather - Wished you were here" she beamed to another as we trudged up the new clubhouse.
Tuesday 30 Aug: Course closed but "I want to go to the gym - with LL" She did the treadmill.
Wednesday 31 Aug: Played alone round of golf (I was at TMCC)
Thursday 1 Sept: Sumptuous Lunch at Mayim (Hebrew for water) West Mall with J. Someone was also lovingly scolded by her at work- she was in her element. 4.10pm I called her and she said 5.15 at the garbage, Bukit golf location. Her voice was somewhat nasal, as if a cold was coming.

The Incident

5.35pm Teed off Bukit front - nice finish on 1st & second hole. At the 3rd hole her drive was good. After her second shot (6 pm) she stopped walking at 200m point and said "Oh I have a very bad headache...need to sit down". I said "Sit away from the tree, you might have ants there". Then she went down limp, eyes closed - "Oh very bad headache...". Lets stop and I'll call the marshal to buggy us back, I said. "Wave to the golfers behind to pass", she said weakly, eyes still closed. After a few minutes the back golfers drove their balls and came towards us, while I ran ahead to retrieve our balls after calling the marshal for emergency. One golfer tried to lift her but she couldn't move. The marshal arrived as I ran back and carried her wholly onto the buggy. "I need someone to lean on", she barely whispered. 3 of us on the buggy and 5 minutes later the marshal had already alerted and arrived at the emergency treatment room, all this while she was immobile but limp. Another marshal on a buggy was heading back to retrieve our trolleys (her's manual and mine the remote controlled powered cylinder). As she was being carried on stretcher bed a volunteer doctor was already there. Dr. I John was formerly NUH (now living in UK) with his wife, a trained nurse. He had responded from the gym. He check her vitals and found her cold but otherwise normal, while she administered oxygen. 25 minutes have passed and he reminded me that the ambulance must be called. I ran out and found that the call was made at least 15 minutes ago! Must be traffic. When I ran back in the third time I heard her garbled voice about vomiting, not wanting to soil anything. After spilling it out she seemed better but her grim look tells a different tale. By the time the ambulance came (6.40pm?) she was semi-delirious and it was strenuous to see how hard it seemed to transfer her. I was allowed in the co-driver seat. "Neuro-care" must be the word given to the paramedic. It was a wild-ride of my life, sirens blaring thru the 6.45pm traffic. It was traffic! A little after 7.15pm we arrived at TTS, she vomiting most of the way in the ambulance (as I learned later, thank God there couldn't be another more suitable hospital) When I saw her transferred on the A&E stretcher her voice was becoming incoherent  "I want to vomit...OooOh headache" as she passed out. A little while I had to agree for her to be intubated. We languished at admissions for a further hour.

Historical Note: Miranda has no previous history of cerebral or coronary problems, other than the fact that her father's death started with a stroke. Her secretary attested that she has never taken a single day of medical leave and her medical screening would never suggest an impending rupturing aneurysm. What would? Even the brain scans earlier 2011 for her motor movement problems wouldn't. Three weeks earlier on National Day we grieved over PI who died suffering 16 hours from amoeba infection in the stomach. She's the most intelligent dachshund we ever had (I am still grieving).

Restoring the pillar

8pm (Thurs 1 Sept) The life-saving procedure of relieving cranial pressure had started. It would be a couple of hours of further waiting, then more scans. Around 10pm we were introduced to the consultant who explained the initial scans shows a ruptured aneurysm, where is it, patterns of occurrences, treatment and possible outcomes. Haemorrhage white blobs on the scan was still relatively small. After questions he left to work on stabilising the brain.

Snatched from the Jaws

Friday Sept 2: Around 1.15 am we returned to hear from him that the haemorrhaging had not stopped but actually worsened with extreme cranial pressures. In point of fact there was not much that can be done when both pupils were already dilating. We had to wait out the worse. Someone burst into tears. There was a hush as he left meekly to let it sink in. But not 5 minutes later he returned and said the pupils have responded to a drug (thiopentone?) and the brain has a "calming effect". "If there is a time to remove the major clot this is the time", was the pronouncement as he left the room for my deliberations. Please do not shut the door on the Lord, was S's prompting to me. I knew I had to rush out and shouted to proceed. But they were all ready, scrubbed and systems to go for the next 4 hours. By this time all sleep had fled.


Friday Sept 2: (5 am) I was not even in the front door of TTSH when I could hear the surgeon's voice on my hp. After he had sat me down he said all was done - the ruptured aneurysm is now clipped with 2 titaniums, the brain is starting to stabilize. There was actually another minor one "outside" the brain but that have to wait another day. She would be in deep coma now for who knows how long. (But God knows)        <I cannot remember rest of this day now>
Saturday Sept 3 (10 am): I could not hold back the rush of tears as I saw the bloated left eye bruised bluish. But that was the extent of invasive correction. She'd lost part of her scalp for now. But everything should start to normalize, physically. But how about neurally and chemically? God only knows, and He does. There is one more scan - radiation with computer tomography - a spin-off application from the FFT (Fast Fourier Transform) technology providing a non-invasive 3D image, revealing any physical defects deep within an object.
Saturday Sept 3 6pm: Given a recovery rating of 5 on a scale of 3-15
 Thanks HL!
Saturday Sept 3 (11.30pm) Ernest's phone call raised me from my bed. I called back the consultant-surgeon and received the first good news of the debacle: the CT scan visually shows no physical damage.
 The brain still swollen, has some residual clots - but this will go away. No infarct - enough to make someone joyful for the day. But what about neural and chemical - how it'll affect cognition? Only God knows - and He does. I slept that night.

Sunday Sept 4 (noon) Philip Y, who had just touchdown from Boston night before was thoughtfully pensive - "Brain vessel ruptures are becoming prevalent..." I had gleefully shouted at Miranda "Here's Philip - time for durians !" She must have heard. The rest of the day I must encourage her friends to talk to her - it could only be good.
4pm - Church elders came and pray - anoint her. Quite a crowd.
5pm - Someone thought she actually saw her eyelids twitched - but touch and talk must be the balm of the day. Nana's loving touch moved her the most.

Next 48 hours is crucial for higher level functions. The process of impaired cerebral recovery is not well known to science and is beyond medicine at his stage. No drug (outside China?) is known to speed cognitive recovery.


1. Please remember to sanitize if you plan to stroke her and mask when you speak to her. This IS encouraged as healing should begin from the left side. Correction Sept 5 - Somehow too much aural stimulation is not good.
2. Please share this site on with people who knows Miranda (she loves her enemies too) as there may be more medical info leaking in.
3. Someone found using valet parking cheapest for long term (4-5 hours), others use Novena Square if TTS overflows (often). For Wollerton study group members AP's place is only 5 minutes (he may charge a nominal fee!!!)
There will be 2 more upcoming blog posts: "Restoring the pillar" and then "The Road back" As the Lord develop events next week. (He has already heard us - so be it Lord)

Latest (Sunday evening) Running a fever - full sepsis workout/antibiotics now. Visitors please be vigilant. Thanks deeply.

Monday Sept 5 1 pm: Had to do the uneasy task of collecting her bone-flap (non-reusable scalp fragment, pate) from the mortuary. But it was properly wrapped of size 8cm triangular shape. Depressing! But who will throw a part of Miranda away?
Other Blog pages: Restoring the Pillar- The Road Back?- Starting Over- Turning the Corner?- Home Therapy


  1. As it may contain medical information I had originally wanted only Miranda's friends to view this post but now it is open to all. Ive asked the attending physician to review the blog so that I can ensure accuracy as well as preserve patient confidentiality of sensitive information

  2. We wish Miranda a speedy recovery so that we can all enjoy the Mountain Cat Durians together.

    Kong Peng and Winnie

  3. I saw Miranda on Friday afternoon after her surgery and thereafter, daily. She looked fragile and motionless then. It is heartening to see her recovering progressively. This morning Andre Choo and I saw her moving her legs and even stretching her neck and body. This is the Miranda that we know, full of fighting spirit and with the will to persist and never giving up. Keep it going!

    Kong Peng
    6 Sep 2011, 1415h

  4. KP, I managed to hold my posture whole of Thursday/Friday. But there was a rush of tears when old friends come hugging. Early Saturday Sis was there alone and she said "Only Miranda promised...and look at her" - the dinner on Tuesday she had announced her baptism and invited all. Now I know a little on when "Jesus wept".

  5. I only just got to know about this site (thanks Jolene). Kian, I was just brought to meditate "My grace is sufficient for you" - may it be an encouragement.
    Christina (ex-BTI admin staff)

  6. Thanks Christina. I belong to the group of people who don't mind praying but find it harder to be prayed for.

  7. dear Kian
    thanks for sharing your deepest thoughts on this difficult journey. We are blessed to see GOD's mercy every day with every small step of recovery Miranda makes. HE is renewing our faith every morning and I am sure the day when Miranda wakes up and smile at you will be just round the corner.
    Kong and Winnie

  8. Dear Kian,
    There are many who are thinking and praying for Miranda's speedy recovery. So God must be bombarded with requests and petitions. I know of many whose lives have been touched by Miranda..they, like me, will be checking this site anxiously every other hour for news of Miranda. God Bless you and the family (+ doggies) as well. Thank you for sharing with us.

  9. Thank you Kong and Winnie, Anon. If you have nice memorable photos to upload please email me. Just learnt how to do it!

  10. Come to think back on this, if the aneurysm burst would have occurred a month or two later in October 30 or November 22 she may be hopelessly lost in Malacca or Nepal! Thank God!

  11. kian,
    I am back from my trip after 19 Sept.
    I shall call you and see if I could visit Miranda sometime.
    I have told Maureen and tell her to read your blogspot and also Yeeling. All of us are praying for Miranda [ even me, who usually have others pray for me ]

  12. Chow welcome back! She misses all you $advice! Pl call me as many times inaccessible because the nurses need to work on her. Many have come, waited but cannot see her, including Chairman Astar!

  13. Dear Kian,

    Great to know all the good signs, thanks for letting us know! Recovery is on the way and hope she will see us next week!!


  14. Dear Kian,

    Thank you for keeping us updated with your blog.
    We are also praying for Auntie Miranda's speedy and sure recovery--

    Please take care,
    Ken, Michiko and Chieko in Japan.

  15. Dear Uncle Kian,
    On behalf of all of my family, we would like to express our love and sympathies to you and Aunty Miranda. Aunty Miranda has always been my favourite Aunty, and I am very saddened to hear about her state..........
    Do keep blogging, as it helps us all know how she is.

    We'll be praying for her.
    Take care,
    Philbert (in Australia)

  16. Thank you FC, Ken, Michiko, Chieko and Philbert!!
    Had a pall of sadness that it will be some time before you can see the original Miranda. Thanks for making my pain lighter.

  17. Alan Colman and Justine Burley have just learned the sad news about Miranda's collapse. Miranda is a wonderful person, a valued colleague and a dear friend. Alan and Justine wish Miranda all the best, and extend their support to Kian and family (including the lovely dachhunds!). Thank you, Kian, for sharing. We are with you and Miranda always in spirit and we will visit Miranda this week.

  18. Thank you Justine and Alan. Skipper(one of the two who used to sleep near her) has had sleepless nights too We are now left with 5 as PI left us on National day.

  19. Hi Kian,

    Good to know that Miranda is progressing well. Her fellow BMRC Directors send their well wishes to her for a speedy recovery. If you need more info after the colonscopy, please contact HL as he is a specilalist in that area. Let me know if you need help with this.

    Kong Peng

  20. Hi KP - Actually I still have some doubts about her planned colonoscopy today and wonder whether HL has read the latest news in "Restoring..". I have not seen the CT scan and the surgeons are sure there is a growth. They are also sure that it is still there after the colostomy, even though there is no X-ray or CT scan to confirm whether that blocked part is still impervious to stools.

  21. Hi Kian,

    It is great to know from the colonscopy that there is no tumor or blockage. What a relief! Now, we just have to be patient and wait for Miranda to wake up. It has been 3 weeks and she is constantly in our thoughts, day in and day out. Many of her friends and colleagues are eager to visit her again if it is alright with you.

    Kong Peng and Winnie

  22. Thanks KP and Winnie. The ICU team feels that she should be ready for general ward this weekend. The final decision comes from the attending neurosurgeon. Please wait till then. Of course you're welcome to see her in the HD ward now at bed 6. Many are following her state - thanks. The hits totaled 11250 last week.

  23. Dear Kian,
    Though the general prognosis may be not too sunny, there are many cases that people can have high degree of normalcy after similar trauma. Good that most of the hurdles are over now. Have faith and Miranda will wake up and recover. Our thoughts are always with her, thanks for keeping us informed of her progress.

    Best wishes,

  24. Thank you FC. The neurosurgeon's prognosis seems a little guarded, miracles are never explained, nor accepted medically. But did you read the page on "The Road Back?" - Miranda opened her eyes for the first time today at around 4 pm, though only for a brief moment. We'd hope she had done this 2 weeks ago, but better late than never.

  25. Yes, indeed I heard about it when I visited yesterday. Eyelids movement is also evidently with much more strength, her waking up is just a matter of time!

    Best wishes

  26. Upon recall my clear mind now tells me that her vegetative state today would possibly have been minimised if the surgery to removed the clot had occurred sooner - not 3.5 hours after the attack when the ctscan showed a span of 65mm haemorrhage (9.35pm), but soon after the angio-gram at 7.30pm. How could a improvement of medical response be made in her case?