and when she speaks
Saturday, February 28, 2009
Dearest Sakthi came by to the hospital and took me out for lunch and ice-cream =) That was so sweet and thoughtful of her :D thank you babes =) She came by another day with Raj and we met up with Sabrina in MidValley and hung out over french fries at Carl's Jr. And then, she and Raj both came to the house for dinner; and we three walloped two containers of ice-cream -.-' *laughs* We FINISHED one whole tub! Just the way we like our ice-cream. All wiped out :) And spotless We watched REC. and munched continuously throughout the night. I warned you Sakthi; if you live with me, you'll put on weight! And then, after Raj left, we watched another movie in the TV room til' I konked out. Poor Sakthi was freezing and she switched off the air-conditioner in the early morning hours! ;) I left for work; and she gave me a big, big hug =) And we forced her back to bed =) Love you dear :)Sabrina, thank you for the gorgeous handmade picture memento and the teddy bear :)Haslina has been ruining my diet for 2 weeks! LoL. She has such a beautiful heart. I gave her a whole container of pineapple tarts which she happily devoured! Her pregnant belly can really eat! Which means; I suffer as well since my poor willpower to resist falls prey too -.-' My thick book on Care of the Elderly has arrived from Canada already. Which means assignments; here I come!I'm loving all my patients. There's this one cute (I think he's so good-looking; with some mat salleh features :p) 93 year old Chinese uncle whom I always smile each time I pass by his little ward. And he waits for me to see him and gives me the most contagious happy smile I've ever seen. I love him to bits! We found out he's got 2 wives; oh how scandalous! LoL. His daughters came to me and told me that their father mentioned to them how concerned and caring I am. One of them said I was a great doctor and the other said 'What a young and pretty doctor' to which I bashfully blush lah... *hehe* And then, I corrected them and said I was still a medical student (though almost done soon! :D).I have to admit I do have favourites amongst my patients. But, I don't practise favouritism in any way =) But there are those I love seeing each time and they really light up my days :) Yesterday, we had a farewell celebration for the two house officers; Haslina and Fitri. Haslina and I walloped on the two Secret Recipe cakes; chocolate walnut and carrot cake =) and then, Diana and Suba went to One Utama to buy French pastries! I can say it over and over again. The team is made up of such warm, wonderful individuals. As much as I love geriatrics; I don't think I can pursue this as a career for long term. I love taking care of old people but dealing with deaths so often is something I don't think I can handle.It will drain me, emotionally.I can detach myself but I don't like to lose the human connections I share with them. That's why I like this field. I don't ever want to be jaded and lose the compassion and the emotions that come along with building rapport with your patients and their family members.If I had someone I knew who was a patient, I'd like to be kept in the loop by the doctors. I'd like my doctor to be honest and truthful to me, and let me know what they're doing and what is going on. Most of the time; due to lack of time from the doctor's side; it's hard to blame them for having limited time to explain to family members... I know how hard-pressed they are. They do try their hardest; though not all do.As for me; I always make sure to let the concerned family members know what is happening and how their ill family member is doing... because I know what it's like to feel absolutely lost and confused. And helpless... unable to do anything for your loved one. And I don't ever wish for them to feel that way when their loved one is on the death bed.I'll be meeting up with cheeky ol' Kathryn soon! :) That loud-mouth is my partner in crime when it comes to chattering; only she can beat me in talking non-stop... *laughs* :P Love her to bits lah!Dear Sze-Sze has started IMU already. How time flies. I was just talking to Hendrick last night. That was us 4-5 years ago. Us little cikus. Now, everyone is onto becoming a Dr... the fond memories. Cheeky Hendrick asked me about my relationship status :p I like what Han Chun, a friend overseas said to me regarding my experience with my first dying patient in UMMC:'That's how life goes. Sometimes you win, sometimes you lose. I guess you can chalk all that to experience and make you appreciate what you have'Couldn't be any truer :)
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7:03 PM;;
Tuesday, February 24, 2009
I hope my patient made it to her home two hours away in another state to die in her own house; back in Negeri Sembilan. She told me a few days ago; when she was still perfectly capable of sitting down in the chair beside her bed; that she wanted to go home.She repeated this everyday I saw her last week. I told her 'We don't want to keep you in here for too long either.. But we want to make sure you're perfectly healthy before you can go home.'She stubbornly persisted and didn't want to believe me.Then, I used the 'children' talk... hoping it'd help her cooperate with us in trying to help her get back to her feet again and get better.'I'm sure you want to go back and see your kids and grandchildren for a long, long time more, right? That's why we want you well and better.'To that, she kept quiet. I'm sure she'd have agreed on the inside.We were about to discharge her the past weekend. Until Sunday came.This was the patient whom I had to poke 3 times to get blood the first time I met her. Hazlina told me you're lucky she likes you; this morning, she whacked me. I laughed. She was very very cooperative with me when I had to prick her for blood. In the end, I succeeded in taking blood from the dorsal part of her foot- a very painful area for needle pokes. Sunday came and she was breathless according to the charts.Monday morning rounds; we knew she was in trouble with her becoming more short of breath and having early signs of labored breathing... We transferred her to the high dependency unit-HDU where these patients who are in more critical state are observed more closely.She whispered to me once she'd rather die at home than stay here for treatment. I couldn't say anything. She was headstrong and already made up her mind.Deep inside me, I've agreed with her going home to pass away but as a doctor who wants her well and believes there is hope in treating her, I cannot say that. I do think that's the best way of leaving this world; being in the comforts of your home. In familiar surroundings and with loved ones by your side.I've always thought her beautiful and graceful, despite her old age and disease.She told me again that she wanted to die at home. This, I remember very clearly.Today, she was quickly deteriorating.I have been her daughter's main liaison with the team as her daughter is most fluent in Hakka.The team rounded and she was one of the very first few we rounded on this morning. The doctors all tried asking her questions but she responded to none.And we moved on, thinking she's not conscious.When the team was with the next patient, I gave it a shot and nudged her. 'Po po, po po'And in my Hakka , I asked her if she could hear me.Despite the labored heavy beathing, she nodded. Then I told her if she's in pain to let me know, we'd do everything we can to make her comfortable.Her eyes were shut. Her chest was heaving up and down. She was struggling to get some breaths in... And you could tell, she was slowly slipping away. She suffered a massive heart attack from the pneumonia we thought we had fully treated. Instead, the pneumonia surprised us and got worse on Sunday and led onto septic shock and then, onto heart failure with the heart attack.She answered all of my questions with a nod or a head shake... And I immediately went to tell my head doctor.And, they rushed over. She was still cognizant. Pain relief would be our first and main priority. Patient comfort.WE injected a venodilator for her heart for pain relief.She only responded to me. The other two doctors tried again. but to no avail.I took on the responsibility of making sure she was as comfortable as she could be. That her last few dying moments would be as painless as possible. That her family was informed of the guarded outlook. That her daughter would have to know the truth that her mother may not survive past tonight, as painful and as hard as it is to swallow that fact. They have to prepare themselves for her passing.LAst night itself, I told her daughter to gather all her other children to come and see her as she doesn't have that much time left. They need to know so that she gets a chance to see everyone before she leaves.When her daughter asked me how long her mum would have if they took her home today; 2-3 days ? she asked.I said 'It's very hard to say. But I think it's best if you gather everyone there because she doesn't have much time left... A few hours maybe once the inotropes and Oxygen come off with the ambulance. Or a day or two, at most' After she finally realised how little time she has left with her mum, I saw her eyes brimming with tears and she was close to breaking down. That was so painful because I don't think she realised earlier how close to death her mum is. And I couldn't do anything but to pat her on her shoulder and hold her for awhile...She followed me in to the ward. But what was worse was that the afternoon rounds was still going on for the other 3 patients; and she wasn't allowed in. I felt so so bad.I went in to check on her, interrupting my following the team for rounds every once in awhile.Making sure she's still there.Right before I left for home, the arrangements were being made for a private ambulance to take her home.I went to her; and spoke to her.'Po Po, ngi hoi hoi sim sim on on lok lok zhon wu ka tong ngia zhai tong moi tong ngi yi che'I repeated it a few times. "Po po, go back peacefully and happily, don't worry, your children will be with you"To that, she didn't respond. No nods. No head shakes. No signs of cognition. And I was worried.I nudged her and shook her a bit.Popo, can you hear me? in my Hakka.She finally nodded. And to that, I have said my goodbyes to her.I touched her son on his shoulder as I walked past him, and saw his eyes filled with tears.I didn't want him losing control and breaking down. So, I left right after that and gave him a supportive encouraging nod.I'd miss the stubborness from the grandmother. The funny bent knee position her right leg took each and every time she was lying on her bed to the extent all the doctors would always mistake her for having an amputated leg; not realising one leg is bent and hidden under the blankets. And the Hakka conversations I had had with her for the past few days.I enjoyed taking care of her. Wherever you are, right now:-Po, ngi hao hao zhao gu chi ga lah. Take good care of yourself, po.
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9:51 PM;;
Mum picked me up first today. Then, onto Syeyi and Syu-Syu in Sunway, and lastly Sze-Sze in IMU. So, then all of us were in the car with mum.Syeyi suddenly out of the blue, asked mum, 'Mum, has jie been talking non-stop since you picked her up??'Mum says 'Of course lah. My poor ears'Syeyi asked me with deep curiosity and to my surprise, with an astonished voice. She knows me well enough, or so I thought... She asked me, 'JIe, where do you get all the energy to talk so much?' -.-'I don't know what to think or feel or make of that. LoL.It's after dinner and I wrote this cos mummy just related the story to dad and I laughed...I said 'Mum, don't make me laugh. I've got a very bad sore throat.'Dad laughed and said 'THANK GOODNESS!' -.-'
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9:42 PM;;
Thank you Kathryn for being my lunch buddy over the phone =) whilst I sit on the 'historical bench' surrounded by the red ants =) for the first few days in UMMC whilst every other doctor on my team rushes off to complete their duties in the ward or catch up on sleep in the call room or perform their duties in the Emergency Ward. Happily I sit and catch up with my dearest buddy. Til' my ears ache from the hot, burning sensation I get by being on the handphone for many a minutes :DI love my geriatrics team. I feel so part of the team now that I'm more hands-on and more involved in the patients' care :) I love each and everyone on the team whom I'm working with. My closest friend on the team; dearest Hazlina who is happily 6 months pregnant; who's laughed at the size of my pear I brought for lunch (t'was as big as my face :p); showed me how to eat chee cheong fun with yong tau fu together -.-', taught me how to take blood from scary, writhing, sometimes, aggressive hostile patients :), my gossip buddy during our free break (rare!), my go-to-any-free-drugcompanysponsored-lunch buddy ;) ......... The doctors on the team are lively, free-spirited, so warm and have hearts that's overflowing with love and compassion - the perfect recipe for the perfect working team taking care of old people. I present you with the Geriatrics Team :)This afternoon, I was called across the hall into the opposite ward by a nurse; stating my staff doctor wanted me there:- to t.r.a.n.s.l.a.t.e. =) You see, I'm a HAKKA; and that's the only dialect no one can speak in the ward. Except for moi :) Then, she asked how long will I be with them and gave me a cheeky grin 'Months right?' ... I laughed and said 'Unfortunately; I'll only be here for 2 more weeks!' ... and she muttered 'Damn' under her breath *laughs*Sadly, back to the same patient; after the team left; she asked me quietly; if she can go home soon.I asked her why? after explaining that we'd want her to be a 100% well first before we send her home. I then realised her concern.'How much does it cost for me to stay here?' I told her assuringly in a serious tone 'I don't want you worrying about that. You focus on getting yourself well first and we'll worry about that together later. Ok?'
And then, she smiled. It's disconcerting when financial worries are the reasons behind why patients compromise on their health. We should be supportive in every way we can; ourselves being in the forefront of the healthcare industry.Don't turn them away for the sake of your financial gains.You've taken the Hippocrates Oath... Help them out as best as you can.Refer them to and assist in providing resources ie social workers to help out with their social problems.
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8:54 PM;;
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6:43 PM;;
