Ignorance? Education breakdown?

Everytime I see patients with long standing, non-healing foot ulcers due to their poor sugar control, I get furious.

Am I mean? Should I be emphatic? 

Most of the time, these patients (and their family members) are either ignorant or stubborn, or both. I am not referring to those of below average socioeconomic class. These are fairly educated and financially doing-OK patient.

One of them was a known diabetic for over 10 years. Decided to default treatment and follow up and self-monitor his blood sugar level at home (wonder if he knows what's the normal range and what he does to deranged levels). Eventually, complications kicked in.

He started with an infected toe, progressed to a foot ulcer. Went doctor shopping at various private hospitals. Consulted many doctors yet none of the doctors advice was taken seriously. Refused for toe amputation. Ended up with sepsis due to a gangrenous lower limb and got admitted to where I work.

An emergency above-knee amputation had to be performed. Yet, the infection wasn't controlled. Wound healing was poor. He was counselled for hip disarticulation.

I can understand if patients are saddened over losing their limbs. He and his wife refused for the surgery.

What surprised an upset me was, the wife started telling us that they had been to private hospitals (while it was only an infected toe) and the doctors gave the option of trial of  antibiotics if they don't want any surgeries. So she thinks the private doctors' opinion is more valid and we should follow. And she took out some herbal lotion and insist on us doing dressing for her husband's amputated stump with it.

Another gentleman. Also a diabetic with Multiple hospital admissions due to an extensive infected sole. Despite spiking fever and pus pouring out from the almost-eaten up sole, he and his wife do not want any amputation. They only want dressing to be done.

Not only that, the wife wants us to write a referral letter to a particular private hospital to get his dressing (only) done there but still wants patient to be admitted in this hospital where you get free food and don't even have to pay a cent. Hey! What's wrong with the dressing that we do for you? Do they think that we provide substandard treatment?

Why oh why are they so ignorant? Why don't they see the gravity of the problem?

So, who is to be blamed for the ignorance?
Patient themselves?
Lack of disease education?
The system?

The solution?
Counselling and more counselling.
Reinforce again and again.
I still believe education is the key - education which targets the community based on their mental acceptance.

* Note: we are no butchers. We treat. We don't intend to chop of limbs.

India and Peace?

A terrorist bombing.
A 4.2 quake.
Both happened in Delhi.
On the same day.
7 September 2011.

Hope all my friends and their family are safe in Delhi.
And also hope that nothing shall hinder my trip to North.

Please say a prayer for India.

Finally (almost)

Despite being in India for 5 years, I have yet to visit Taj Mahal.
In fact, when I was awarded my scholarship to pursue medicine in India, I had doubts. I was reluctant because in my opinion, India is overcrowded, dirty, smelly, etc etc.

I still remember I was sitting in the lecture hall in Kedah Matriculation College. I was not in the mood to attend lecture (such an emo teenager back then). When the lecturer started the class, her desktop wallpaper showed up on the projector screen. 


It was a magnificent picture of Taj Mahal which left me in awe.

Immediately I shook my friend who was sitting next to me and told her, "That's it! I am going to India. Because I want to go to Taj Mahal."

That was how I made up my mind to study in India.

Now that I am almost done with my degree here, I still haven't set foot at one of the wonders of the world.


But I'm on my way. Currently in the planning phase. Hopefully my dreams come true next month. 

"My hobby is to become a doctor"

Mansi was visiting her grand-uncle in the private ward when she decided to popped her head in front of me and watched me complete some documentation. I smiled at her and continued my work as I was running out of time to complete the many things unaccomplished. She was watching me for some 10 minutes and finally decided to talk to me.

"What's your name?"

"3R1N, and yours?"

"Mansi."

"Are you from China?"
*laugh*
"Err, my grandparents were."

"Who are you visiting?"
"My...erm...grandmother's...erm....brother."
Perhaps that's too complicated for her to relate. 

"So do you want to become a doctor?"

She nodded eagerly with a big smile.

"Is that why you are so interested in what I am doing right now?"
"Yeah! My hobby is to become a doctor." *Full of confidence*

WOW!!!!!
"You mean, your ambition?"

She blushed. Oops.

"How old are you?"
"I'm 12years old. I go to i-cant-remember-what-she-said School."

"Can you read what I'm writing?"
"No. But you write very fast."
"Hmmm, well, I have to."
"Does your hand hurt writing so fast?"
"Not really. I'm used to it."

"So what doctor do you want to be next time?"

Since she is so ambitious and confident, I thought she might already have a speciality in mind.

"I want to be like you."

*pause* "HAHAHAHAHAHA!* 

Seriously, I just got to know her, or rather, we just spoke for 5 minutes, and I wasn't even attending to a patient, I was doing paperwork. Which part of that impressed her? I am just an intern. I am not one of those consultants who walked with aura and a flock of postgraduates,house surgeons, nurses and students scrambling behind him.

For a kid like her to be inspired to become a doctor, I pictured a scene like this.

A doctor swings his stethoscope around his neck, rushes in behind the curtains, performs CPR frantically, shouts "CLEAR" and then pushes a pair of iron-like-thingy into the patient's chest and made the almost lifeless fella bounce 2 feet high, and finally the flat line on the monitor shows some spikes.

This was what we used to see in the Hong Kong soap operas before House MD and Grey's Anatomy era.

"So, do you know that besides this ward, there are other wards on the other side of the hospital, which is the free ward, where the poor patients are admitted because they can't afford the medications and surgeries?"

"Yes."

"So, next time when you become a doctor, will you attend to them? The free ward is not beautiful like this one is. It is very crowded and pretty uncomfortable to be at. They are not educated like us. But they are ill too. Will you treat them like treating everyone else."

"Yes." No hesitation at all.

She's a sweet girl. I hope when she grows up and successfully becomes what she wants to be, she will not forget what she said.

I enjoyed chatting with her. I asked if she will come again tomorrow and at what time. She ran off into the room and came out as I was leaving to tell me that she will be here around 5 to 5.30pm. She was still walking with me all the way down the corridor until I exit the door. But I told her I may or may not be here at that particular time. She says ok. 

I wanted to exchange emails with her. Unfortunately she doesn't have one. She only has her father's.

She made my day. Not because she wants to "be like me", but talking to her lighten up my mood.

Immediately after I left the private ward and went to the free ward, I had a bad time with my blur, bossy, annoying, problematic superior. It really irritates me when someone gives you instructions when she herself is confused about what she wants to do. I tried so hard not to explode and kept reminding myself to not let this ruin my happiness. Sniffed back the escaping aqueous, I finished my work and called it a day.

Sandwiched

I am sandwiched between two groups of human being.
The educated, well-dressed professionals.
And the illiterate, shabbily-clothed patients.


The former is arrogant, has poor leadership, yet likes to shout and order people around, equates anger to awesomeness and frustration to greatness, and whines all day long wondering why does his or her life suck.


The latter is humble, polite, patient, soft-spoken, does not know much but definitely will not act smart, and most importantly, poor but is generous enough to spare you a smile. Definitely contented.

Keeping the sandwich in perfect shape is important to keep the system running.
Hope this helps me level up my EQ.

What keeps me going...

Was feeling very frustrated after my 24-hour labour duty the day before followed by long hours of standing and going round and round the ward, depressed because I didn't have time to have breakfast, looking forward to finish everything off and leave the hospital, when my boss (whom everyone fear) decided to ask me attend to her private patient.

Argh!

So I started my duty as a part-time unpaid hospital tour guide and provided the best VIP service. Service and destination includes:

1. Escorted the patient to the Ultrasonography Room. Lined them up. Waited for their turn. Told them when they asked why do they have to wait so long. Waited while she got her transabdominal ultrasound done. Waited while the consultant explained to them about the scan result.

2. Thank god my boss was kind enough to let me go have my luch first. Actually she just let me off because she wants the patient to go have their lunch before the following procedure, that's how I got my chance off.

3. Met the patient at a time and place we agreed on before parting. Waited because they came late. But they got apologize lah. no big deal. anyway by that time i already had my lunch and felt a little better.

4. Escorted the patient to do PPTCT Counselling. Waited for the person-in-charge to come.Waited for her to do the counselling. Waited while they do a simple test. Waited for the next 15 minutes for the result. 

5. Escorted them to the lab. Explained to them why blood and urine test are needed because their question was: Didn't we get a scan done already. Why still need to test some more?
Felt like telling them, if you have doubts with what is to be done in the hospital, then dont come lah. Deliver at home. No need go through all the waiting and scanning and blood testing etc. Nope, of course I didn't say that. I'm not that kind of doctor. Come on!
Showed them where to make payment. Waited while she get her blood sample taken. Waited when she waited for her bladder to be filled up enough to evacuate them into her urine bottle. 

6. Escorted them to the labour room. Found her a bed for her to lie down. Informed the doctors on duty about this VIP patient of my boss. Actually, it is easy to get things done when you mention my boss' name. They did not procrastinate for even a minute to carry out the instructions that my boss has given. They connected the wires to put her on Non Stress Test, and I answered to the patient's question "What is this for?" Well, this will detect your baby's heart rate, and contractions of your uterus, and all these will be shown on this graph which is getting printed, including how many times your baby moves when you press this button. After 10 minutes, she said : "Actually I don't really understand how this thing works." So again I explained. Honestly, I've never seen any doctors give such lengthy explanation to patients in this hospital. Maybe most of the time I'm exposed to free ward patients, who are illiterate and ignorant. 


7. Waited while they wait to repeat Non Stress Test. It happened that the NST didn't turn out to be satisfactory as the fetal heart rate tracing was not really reassuring. So the doctors decided to do a second tracing. Trying to be positive, perhaps the baby is fast asleep. So they let the patient relax a bit, take a break, eat some biscuits, drink apple juice. But this definitely didn't do any good. The husband started asking why do they have to do a repeat test? Was there something wrong. They were getting anxious. And I definitely don't want to worry them more. Being a junior most doctor in the whole ward, I didn't want to say the wrong thing to them. So I ask the doctor to do the explanation. She gave them a not-for-layman explanation which I'm pretty sure did not help calm the patient down.

8. Connected the phone to the operator and then to my boss. The husband got restless and wanted to talk to my boss. And boss' phone couldn't get through. So waited and dialed and waited and dialed. Finally, they spoke. My boss gave orders to the doctors on duty and they decided for admission.


9. Made sure the patient is comfortably admitted in her room, was about to bid goodbye. I had waited for this moment since 12pm and it's now 6pm. Mind you I did not get to sit all these while. And she asked, "Why do I have to be admitted? I am not due until 23 August." "OK, well you see, you are already 37 weeks 2 days. Infact, you may deliver anytime from now on because your baby is mature enough already. Like what my boss told you earlier, your baby appeared a little smaller on the scan. This could be due to your familial trait as both you and your husband are not very tall.  But they want to keep a closer watch on your baby and you to make sure everything goes fine. Don't worry." I can totally understand her anxiety and apprehension being a primi. Not that I have any experience.
"Will you be staying back here with me?" She looked at me with her big round eyes. Really, she has big round eyes.

 "Oh, I'm so sorry. Actually I'm off duty and I am posted in another ward. If you have anything you can talk to those doctors just now. They are very nice. You don't have to worry."

 "But you are closest to me. You have been with me since just now. I feel comfortable with you. Will you come tomorrow?"

"I'm sorry I can't promise you yet as I have to complete my duties in the other ward. If I will definitely drop by to see you okay? Rest well."
She thanked me, still looking a bit worried.


I told myself I will find time to drop in to see her tomorrow. I hope it is not inappropriate for me to do so as she is in the private ward and interns don't handle official work for private patients, which means I will be "illegally" visiting her. 


My job as the VIP tour guide is done. But I was happy as I left the hospital. Not because such a tedious and not-my-business duty is over. But because patient was grateful for what I've done for her and she made me feel important as a healthcare provider.

I wasn't cursing my boss anymore for giving me extra tasks and making my life miserable. Instead, I'm glad that she gave me a chance to self-learn how to deal with patients, how to build up good rapport. 


I'm also fortunate that the patients speak English and are pretty well-mannered. The husband got a little cranky after a long tiring wait in the hospital but he still spoke nicely. His pregnant wife must be even more tired than him and I. But I managed to communicate them without any language barriers or emotional outburst.

A simple gesture of appreciation, is what keeps me going.

*When Five Fell*

A short film directed by Wesley Chan from Wong Fu Productions.

Totally love the way he personifies the objects to portray the feelings and connections with a girl.