Between April and September 2015, there was an outbreak of acute Hepatitis C Virus infections in a ward at SGH. Of the 25 who were infected, 20 were kidney transplant patients. Eight of them died. It was the worst crisis Dr Terence Kee Yi Shern had faced in all his years of practising Medicine. The brows of the mild-mannered physician knitted as he looked back on that trying period:‘It was a life-changing event and I was in the thick of it. The feeling was like being a commander looking after this team of soldiers and the soldiers are all dying, one by one, in the battle. As a doctor, you never want to lose any patients, but to lose so many within a short period of time, it was devastating.
That incident changed the way we care for patients in the entire organisation. It started a renaissance of looking into our practices that in the past, we took for granted, things like infection control.’
He is candid about how his attitude towards patients changed after that time:‘The Hepatitis C incident woke me up to the wider world of patients. As doctors, we care for our patients knowing that we will lose some of them. But in the past, I d idn’t really think about the impact of death on the patient’s family.
We had so many meetings with the families during and after the crisis. I remember after one of the patients died, I met her husband and her children. Young kids. Seeing them, I felt like the guy who takes a group out on a boat and then the boat capsizes and everyone drowns but I’m still alive.
I learnt that when a patient dies, there is this big void left in the family. When I visited families with the medical social worker, I realised our patients are not very well off. You could see their living conditions.
Now, every patient I see is not just a patient. I want to know their world, I want to know what their children are doing, what their spouse is doing. I want to know where they’re living. This helps me to treat them more holistically.’
The analogies Dr Kee uses to describe the Hepatitis C incident are all drawn from life and death situations: a commander who can’t save the lives of his men who are dying in battle; a captain who can’t save his drowning crew. The parallels reveal the doctor’s sense of responsibility towards not only his patients, but also his department and SGH.
‘The event made me stronger as a leader and administrator. I became more aware of the wider world of auditing, governance, crisis management,’ he says. ‘Not many people know this, but after the Independent Review Committee’s findings came out, Professor Fong Kok Yong [Chairman of the Medical Board, SGH] convened a meeting.
When I heard about the infection control lapses, the delays in reporting, I broke down and cried. I cried really badly for a very long time in front of everybody. The CEO [of SGH at that time], Professor Ang [Chong Lye], came from the front to the back where I was and gave me a hug.
For so many months, I had been fronting this thing. As a leader, you must be strong. Everybody is looking up to you for leadership, waiting to see what you are doing to find solutions to problems.
Many tears were shed at that meeting. My head of department, Professor Marjorie Foo, stood up and spoke; she also cried. Chief Nurse Dr Tracy [Carol Ayre] spoke to the nurses, many of them cried.
All of us had bore the brunt of criticism on social media. When the news came out, there were upsetting comments like “the doctors should be jailed.” I thought then, you guys don’t know who we are or what happened. No one practises Medicine or nursing to intentionally cause harm. The nature of our job is to care for patients, to provide treatment.’
‘But I was grateful to have the many meetings with Prof Fong and Professor Chow Wan Cheng [Chairman, Division of Medicine]. I always remember Prof Fong’s phrase, “The buck stops with me” and Prof Chow saying to me: “You did the right thing.” Their words made a lasting impression on me. During a crisis, the leader needs to have the courage to bear the responsibility while continuing to give to others even though he is suffering. We wouldn’t have gotten through the HCV outbreak without our leaders walking the talk of “ One for all, all for one.”’
The support of other colleagues also sustained him: ‘Dr Sobhana, one of our kidney transplant physicians, was a good friend who provided emotional and psychological support. Dr Crystal Lim, our medical social worker, sent me messages frequently to encourage me. If I didn’t have their support, I’m not sure I’d be here.’
'When something goes wrong, no one leaves you alone. Even though it’s not their problem, they’re still there.’
He received cards from other departments. People knocked on his door in Academia to ask if he was doing okay. Someone put a balloon that said ‘Be Strong’ in his office.
When the Ministry of Health asked that the patients’ reports be written up overnight and presented the next day, his department rallied around him and worked till late to get the 25 reports done.
When asked about the culture at SGH, Dr Kee smiles. His voice is warm and energetic:‘We get the most complicated cases in SGH and when there’s something that needs to be done, it gets done. There are so many instances where we got together [with people from other departments] even though we may not have known each other before.’
From the time of his first posting as a Medical Officer to Cardiology, the camaraderie and team spirit made a deep impression on him. When he was posted next to Renal Medicine, he was happy to discover that the environment was just as stimulating, the people were just as kind and helpful. He provides a recent example of teamwork and collaboration across departments:‘Recently, we had a pregnant transplant patient whose graft decided to fail during her pregnancy. We had to put her on daily dialysis, she had to stay in hospital throughout this time. Along the way, other complications came in. She developed a viral infection that needed prolonged treatment and there was so much worry that it would affect the foetus.
Her liver function was getting abnormal.
So the obstetrician, the fetal maternal physician, the dialysis specialist, the infectious diseases specialist, we all got together. We had meetings to discuss the case, we did literature review on how we should manage such a complicated patient who was pregnant, has a transplant that has failed and has a liver complication.
In the end, she gave birth to a healthy baby and her kidney function recovered. I don’t think this would have been possible if we weren’t working together, putting the best minds together. All the senior consultants were involved. We were managing this patient together for over five months. We were trying to keep the baby inside her so that it would grow enough, it would be healthy, we didn’t want to have a premature delivery of a baby that would have to be in ICU for a long time.’
Dr Kee shares: ‘After the success of a complicated transplant, there is this feeling—something great happened today.’
His heart for the wider community is transparent throughout the interview. The work at SGH is rewarding in itself. His daily responsibilities at the Kidney Transplant Programme allows him to see patients enjoying a new lease life after their transplants. Last year, there were 30 transplants. Sometimes, there can be as many as four transplant operations over a weekend.
Being involved in public healthcare gives him opportunities to be tested in new ways.
He welcomes the challenges, for instance, in the planning of clinical services for a new SingHealth hospital, Sengkang General Hospital, in 2012:‘I had the opportunity to work with MOH to design and build a hospital. How many doctors get to be part of s omething like that?’
Most of all, he is dedicated to the building up the Kidney Transplant Programme at SGH so that it will continue to deliver high standards of patient care in the present and future:‘My mentor, the previous director Professor Vathsala, taught me the importance of taking pride in everything we do, whether it’s caring for our patients or presenting papers at international conferences.
Since 2014, we have been moving towards becoming an academic transplant programme. We are working hard at research in T-Cell therapy and bio markers.
I believe that we have the expertise in Singapore to do groundbreaking research.’ Dr Kee has received tempting offers to join the private sector and rejected them all.
He says with a big smile: ‘If we don’t take care of the majority of Singaporeans, who’s going to do it?’
Dr Terence Kee completed his undergraduate medical education at the Flinders University of South Australia and returned to Singapore to complete his training in Internal Medicine and Renal Medicine at SGH. In 2008, he was appointed Director of the Kidney Transplant Programme and has served in this position ever since. Dr Kee is also the Vice President of the College of Physicians of the Academy of Medicine, Singapore, the President of the Society of Transplantation (Singapore) and council member of the Asian Society of Transplantation.
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