Category Archives: gomen slave

not as simple

two of my long-term patients died this week. one was a young woman who had a stroke and eventually succumbed to complications from her chronically recumbent state. the other was a teenage girl with advanced cancer. i watched them slowly deteriorate despite our very best efforts. they both died malnourished, emaciated and wholly dependent on others for nursing care.

it’s not my place to decide who deserves aggressive resuscitation and who gets to go peacefully. my opinions have nothing to do with the care of the patient. my job is to give them my everything. but i wanted to cry as i gave orders to the resuscitation team to pump one of the patients with drugs and continue chest compressions. i felt like she didn’t deserve to die in pain. i wanted to stop and let her leave us in peace…but it wasn’t my place to do so.

not for the first time in my career, i wanted to ask for a vial of morphine and help her slip away.

so which patient was it? the answer’s not as simple as you think. doctors sometimes do emotionally-driven things. once, a team of neurosurgeons operated on a man with severe brain injury and possibly brain death just because he was young and they felt he deserved a chance. it’s not easy at all.

i don’t think anyone ever gets desensitised to death. every patient means something to me, and if i feel that way i’m sure all my colleagues do too.

raw

there’s this thing i do whenever i’m nervous. the corner of my mouth trembles and i pick the skin on my fingers until they’re raw and bleeding. the stinging pain of compression as i halt the gentle haemorrhage soothes my nerves a little. my manicurist gives me hell about it.

i saw someone else do the same yesterday. he is a young patient of mine, who’s been diagnosed with cancer. i stood by as the surgeon explained his treatment options – different forms of surgery depending on intraoperative findings, possible outcomes and complications, what to expect once the operation ends. diagrams were drawn, figures were thrown at him. he learned that he could have up to 5 scars on his neck, chest and abdomen as well as a tube going into his lungs when he wakes up from surgery. he was also told there was a chance the tumour may be unresectable.

it wasn’t anything new to me. i’ve assisted one of those surgeries and seen quite a number of patients go home without a stomach or part of their oesophagus and small bowel. i’ve watched the lung collapse on command during the operation and touched a still-beating heart. i’ve smiled at the end of the surgery when the collapsed lung expanded, its pink sponginess returning to its former glory.

i watched my patient lock and unlock his fingers, picking at his nails until they bled. he took in the jargon – anastomosis, stapler, thoracoscopy – without much question. he only interrupted the surgeon to ask if there were any restrictions to what he could eat.

in the routine of explaining complex procedures to our patients, it is usually the ill man himself that reminds us of what matters most: quality of life. he wasn’t interested in the surgery itself or the effort we are making in preparation for the operation. i’m sure he only understood 60% (at most) of what we told him about his condition and the options of treatment.

he just wanted to know if he’d ever taste his mother’s meals again.

i thought of the stressors that have compelled me to abuse my fingernails involuntarily. all of them raised my cortisol levels enough for me to lose sleep, look to the skies, head over to my favourite pub and avoid human contact. they were nowhere near the stress of receiving a diagnosis of cancer, yet those mechanisms of coping are a luxury for my patient, a young man who has less than a week to mull over the choices presented to him in that short 20-minute family conference.

if i ever had the illusion that this job will get easier with time, i definitely do not have it anymore.

snippets…because i’m too busy saving lives

in the past whenever i heard of the death of a child, i thought, “oh he/she lived such a short life.” now that i have a 4-year-old niece who brings me both joy and annoyance daily, i realise so much is invested in a life that eventhough 4 years can be seen as nothing compared to seven decades, it’s still 4 years of milk formula and sleepless nights and anxiety over delayed speech and overreaction to small milestones and stationery and pink dresses. it’s 4 years of love and losing a part of yourself to someone else. that’s not a short life.

perhaps the build up to this realisation is part of the reason i have abandoned ambitions of becoming a paediatrician. at least an adult would have spent some of his/her life independently. but a child…a child cannot stand alone, and to lose someone who is made up almost entirely of the people around him/her is too much to bear.

i’m may draw some flack for saying this, but i am now wholly convinced that anyone with any illness requiring any kind of surgery should head straight to a government hospital and be patient about the timing of intervention.

the laws of my department dictate that every referral must be attended to as promptly as possible. this differs from my previous workplace where referrals can be dealt with over the phone and instructions to admit a patient can be made via verbal order. this makes work rather difficult at times and i’m thankful the patient load at my current hospital is pretty bearable in comparison to other centers.

it does test my patience when i receive a referral for an illness that doesn’t warrant one but i’ve found that it pays off to disguise my displeasure with jokey sarcasm and a smile and do my best for the patient before resuming my precious sleep. i’ll be at this hospital for a couple of years and it’s best to maintain as good a relationship as possible with everyone there.

plus it all becomes worth it when i get an apology for a crap referral or support when i am obviously bullied into managing a case that isn’t even within my, erm, “jurisdiction”. hehe.

part of me wants to publish my monthly on call schedule and tell everyone with abdominal pain to abstain from seeking treatment at my hospital on those dates so i’d get some sleep during my calls. also, if you wanna get into an accident and break some ribs please stay away from the sungai buloh area. our stock of spirometers is depleting at an alarming rate.

and don’t drink and drive or fail your suicide attempts if you wanna avoid getting an unnecessary amount of large bore (read: very painful) venous cannulas inserted on your limbs. you’ve been warned.

i love being back in the klang valley. makes being a part-time fangirl very easy. it’s a pity that job costs more than it pays (it pays zero) and lands me a sore throat every time.

wait, that did not come out right.

wokay back to saving lives. *dons cape*

one month

upper gastrointestinal surgery is a little depressing.

most patients go through months of discomfort before being diagnosed with a devastating, often advanced, disease. they are a shadow of their former selves, no thanks to the tumours which consume every one of their hard-earned calories. the surgeries themselves carry high risk of complications with significant morbidity, while patients with inoperable lesions waste away at an alarming rate.

in the end, not many live for long. it’s hardly rewarding at all.

i wonder if it’s the reason why there’s a less than positive kind of approach to the entire department, despite its optimistic facade.

i wonder how long it will be before my smiles become worn and my patience becomes thin.

first week

every houseman on the brink of completing 2 years of slave-dom should give serious thought to his or her career. what do you want to do every day? what kind of people do you like working with? can you deal with pressure? how do you cope with disappointment?

i realised that i cannot complain about the life i live now because i made all the decisions at my free will. i chose medicine. i chose my university. i chose the place of my housemanship training. i chose the hospital i’m working at now. i chose the department i’m in. i chose the specialty i want. i chose to stay at home.

it is the conscious acceptance of all this that keeps me grounded every day. there are consequences to every choice and i will take them all – the good and the bad.

bamboo river has been alright to me so far. being in a surgical department headed by a man who believes in old-school values and principles and training means i feel right at home. the way things work is not very different from ipoh, which is a relief. the downside is it takes all of 3 minutes to brisk walk from the MO quarters to the emergency department…which is a very long time and distance covered compared to ipoh. i expect some weight loss despite the resumption of meals in the afternoon!

i chose this. i chose a life of early rounds and theatres, lumps and bumps, wounds and tears. i can’t complain about any of it. the only thing i can do is my best…

…and make the most out of being back in the klang valley. urbanscapes on a post-call day after 3hrs of sleep? bring it on.

the last shot

“congratulations, you’re now an MO,” she smiled as she handed me the letter which said someone of authority was pleased to inform me that my transfer request has been approved. it felt like a dream that was neither nightmare nor [insert antonym for nightmare, i couldn’t find a satisfactory one on the web], and i almost burst into tears when i got into the car. in addition to accepting the letter of transfer, i had agreed to a lifetime of government service. it’s a decision i’m sure i will regret when i turn 40 and be thankful for when i’m 60 and diabetic (i have no doubt i will be), but it was only when the doors were closed and my keys were in the ignition that i realised  i didn’t know what the hell i was doing.

half an hour prior to the events above, i reached for the bottle of johnnie walker that had served faithfully as a bookend on my study table for the past year. there was one last shot of whisky in it, which i saved for either a special occasion or an emergency, though exactly what emergency would call for a small amount of hard liquor isn’t very clear to me now. my friends joked about me being a closet alcoholic because i used bottles as decor, but really it was just because i thought they were pretty.

anyway, i had taken the first train to ipoh today and packed up most of my room in about an hour. when i was done, i surveyed the space around me. just 3 weeks ago i moved out of the house i called home for 2 years and made myself comfortable in a room that felt too big for one. i didn’t think i’d have to strip it down again so soon. it felt like a joke that tread dangerously on the line between ironic and cruel.

so i opened the bottle of johnnie walker and looked at myself in the mirror. 2 years and it has come to this. 2 years was too long and too short at the same time. i look much older than the girl in the photograph on my hospital id. i’m coming out from under the cover of housemanship and becoming a real doctor. my heart rate quickened and my stomach churned as a tipped the bottle over my lips.

the last shot tasted exactly as i expected – a burning jolt of reality down my throat.

the rest of the day was one long, exhausting errand. i did eventually break down as i drove home, partly from the strain of yet another move but mostly because i was overwhelmed by gratitude towards God and the mysterious ways He has worked in my life over the last 2 years. during the journey i mourned the sudden manner in which ipoh has been torn from me, how quickly i had to leave. i sang songs of praise to the One who has sustained me throughout housemanship.

i’m still tired now as i type this. i don’t dwell on shouldas and couldas because it’s a waste of time. my run as a houseman has ended and i have to get back to work, back to life. i must remember the burning reality that i am in.

confidence

what makes someone confident?

as the child of a man who literally got off the boat and made a name for himself through academia, i can safely say that confidence comes from knowledge.

as a junior doctor who has seen my seniors cut their operating time from three hours to two to 90 minutes, i can also conclude that practice makes one more confident.

as an aunt who is watching proudly as my sister does an exceptional job at caring for her second baby after exhausting all resources figuring out my first niece, it is clear that time and experience contributes towards confidence.

knowledge, practice and experience…surely my peers have picked some of that up from working as doctors for more than a year? yet a (disappointing) handful of them are still nowhere as confident as an impending medical officer should be.

it’s been a disappointing couple of months, made worse by the fact that there will be no change in environment for the next 3-4 weeks. perhaps i’ll miss it all when i go to a new place with new people and a new system, but right now that desire to leave and never come back is burning even more than before.