Life and Legacy

Tan Yia Swam

The Chinese saying "生老病死" means literally to "be born, grow old, fall sick and die".

It is meant to describe these stages as a natural process and a life cycle, and I agree – but I find it rather morbid. Surely there is a lot more living and fun between birth and death!

Age and ageing

Age has always been one of those sensitive topics. Kids cannot wait to grow up while adults complain about getting older. Both men and women worry about physical prowess, attractiveness and desirability. Many worry about falling sick and dying a long, protracted death.1

I know many people who pursue physical beauty and perfection, wanting to look like they are in their 20s and youthful forever. I am glad that there is a rising wave of "embracing your silver hairs", inviting people (mostly women) to embrace the natural bodily changes of age.

If you google "ageing naturally and gracefully", most of the tips are on physical preservation through skin care, supplements, attire, eating right, not smoking, exercise, etc. Much less is said about mental youth! Do you know someone who is actually 30 years old, but behaves and talks as if in his/her 60s?

Are you thinking of that friend who always says, "In my time, things were better"? Or the one who talks as if there were no tomorrow, "At my age, there's nothing I haven't seen." (cue eye roll) I personally find that it is the attitude of complaining that is tiresome.

Having a youthful vibe requires an attitude of curiosity, playfulness and joy-finding – no matter the situation. Not childish, but childlike. Being willing to try a new experience, being able to laugh at oneself, and being able to pick oneself up and try again. Age is truly just a number,2 especially when one has the physical fitness and the mental resilience to sustain oneself throughout life. It is good to keep track, but I will not be beholden to it, nor allow myself or others to decide what is "age-appropriate"!

Finding meaning

People have always sought to find meaning in their existence. There are many studies, books and articles discussing this topic – anthropological studies, philosophy – of why religions arise, and why we look for explanations as to the meaning of life. Who put us here? Why are we here? What happens after death?

The intensity and desperation of finding meaning were perhaps accentuated during the COVID-19 pandemic,3,4 with social isolation and the threat of death hovering over us. It would seem that the people who best weathered through the past three years are those who have consistently found meaning in their everyday, and in whatever adversity they encounter.

I hope that you have also given this some thought before, whether through reading The Purpose Driven Life (a Christian Bible study book useful as a spiritual journal), watching TED talks or the recent movie Everything, Everywhere All at Once, or surfing social media.

Why are you doing what you do? Is it for money, fun, pleasure, gratification, or some promise of a reward? Clearly, there is no right or wrong answer. We all have to find meaning in our own ways. One guideline I use is this reflection: when I die, how will the people I leave behind think of me, and can I face my Maker and say that yes, I did my best?


Queen Elizabeth II passed away on 8 September 2022, at the age of 96 – being active and performing all her duties right to the end. Her life of duty and service to her people, and her calm, unwavering leadership over the past 70 years have been widely remembered in the weeks since her passing.

Brittany Maynard was an American lady with terminal brain cancer, who passed away by physician-assisted suicide on 1 November 2014, at the age of 29.5 She advocated for the legalisation of assisted suicide for the terminally ill and has helped to change the law in various states in America to legalise medically assisted suicide.

When celebrities pass on, people mourn them – their contributions to others and the work they leave behind (especially those in the entertainment sector, leaving behind books, movies and songs). In a way, they are immortalised. How about everyday folks like us? What kind of impact do we leave on our family, our friends, and our community? We get as much or as little as we put in.

As doctors, I think we are privileged to have the chance to have a great impact on people. Imagine being the one to deliver a baby; the one to break a cancer diagnosis and help the patient on the road to recovery; the one to help piece together a broken life or body; or one of the last at the bedside to ease the passing. At that pivotal point in time, we are everything to the patient and, in turn, their family and loved ones.

When there is negative news on social media about unhappy patients and complaints, the vicious comments by netizens and the reactive anger of the medical community saddens me deeply. It is true; there are so many more new stressors on us doctors now.

  • Rapidly evolving medical advances
    (making each of us at risk of being outdated very quickly despite our best efforts at continuing medical education).
  • Increasing trend of Dr Google
    (leading to time wasted on trying to unravel myths and half-truths before any sort of meaningful consultation can occur).
  • Tightening guidelines on doctors – with almost no regulation on alternative or complementary medicine (it is really unfair for patients to have no recourse, or for doctors to be handling terrible complications/ neglect caused by those other types of therapy).
  • Expanding job-scope and expectations: to be also good at communications, information technology, cybersecurity, teaching and research. In truth, no one can be an all-rounder. I believe that each of us should play to our own strengths and work in collaboration to bring out the best in one another, rather than be one person trying to "bao" (dialect/slang for handle or manage) everything.

In the face of so many stressors pulling us in different directions, I urge each doctor to hold on to the true purpose of why you took up this calling.6 For me, it has always been to help people. And I think I still do my best by attending to the patient right there in front of me, and remembering: "... to cure sometimes, to relieve often, to comfort always".7

  1. World Health Organization. Ageing and health. In: Detail. Available at: Accessed 23 September 2022.
  2. Kluger J. How your Mindset Can Change How You Age. Time [Internet]. 12 February 2015. Available at:
  3. de Jong EM, Ziegler N, Schippers MC. From Shattered Goals to Meaning in Life: Life Crafting in Times of the COVID-19 Pandemic. Front Psychol [serial online]2020. Available at: https://bit. ly/3S9u3UW. Accessed September 23,2022.
  4. Humphrey A, Vari O. Meaning Matters: Self-Perceived Meaning in Life, Its Predictors and Psychological Stressors Associated with the COVID-19 Pandemic. Behav Sci (Basel) 2021; 11(4):50.
  5. Compassion & Choices. The Brittany Maynard Fund. Available at: Accessed 23 September 2022.
  6. Thirumoorthy T. Oaths and Pledges in Medical Professional Culture - Does Analysing and Reflecting on the Words Matter? SMA News 2015; 47(4)18-9.
  7. Russell IJ. Consoler Toujours-To Comfort Always. MYOPAIN 2010; 8(3)1-5.

Tan Yia Swam is a mother to three kids, wife to a surgeon; a daughter and a daughter-in-law. She trained as a general surgeon, and entered private practice in mid-2019, focusing on breast surgery. She treasures her friends and wishes to have more time for her diverse interests: cooking, eating, music, drawing, writing, photography and comedy.