Thinking Position

I stopped writing because I realized in dismay, that the people I trusted most manipulated my thoughts for their own twisted mind games. It broke me for awhile (a few years), but then I realized, I couldn’t begrudge them for their action. My words were out in the open for everybody’s eyes to feast on, so really, I had nobody else to blame but me.

I hope that explained my disappearance for a bit.

I don’t want to forget what happened on Tuesday night, hence the impromptu blog update.

It was a typical Tuesday night. I finished my extended-hour clinic at 1030 pm. By then I was ready to just die on the bed. The cases were typical URTIs with a few MC seekers in between. Balik, ate Aida’s fantastic ayam masak ros for dinner, changed and prayed, and ready to collapse at 11.30 pm. But as luck had it, I got a call from sickbay, informing a 94 year-old (bless her!) makcik, known hypertensive but defaulted, came in with sudden onset of shortness of breath. SpO2 80% under room air, BP was 220/150. In English, shit wasn’t too good. So I left my bed and made my way to the clinic…

Makcik was a delightful warga emas who could still laugh at her predicament. There she was… with a high-flow oxygen mask on her face, chest heaving, and she could still grin and smile at the staff. My staff were awesome… they knew what to expect. By the time I arrived, one branula was already in, ECG on the way. Makcik claimed she felt better on oxygen. Lungs were fulllll of fluid. It was as if she was breathing in a tub of water. Makcik said she had no chest pain, and shortness of breath started acutely while she was trying to fall asleep.

ECG revealed some ischemic changes with LV strain… BP was still rocketing, I was thinking nitrates. While my SN and MA were preparing for catheterization, I counseled the family member for referral to Temerloh.

Grandson: Saya nak pergi Kuantan. Saya duduk Kuantan.
Me: Encik, Kuantan 88 km. Temerloh 50 km je. Ini kes kecemasan, bukan kes biasa-biasa. Makcik ada kegagalan jantung, sampai buat paru-paru dia penuh air.
Grandson: Saya tak nak pergi Kuantan. Menyusahkan saya je.
Me: Encik, tolong faham. Bukan saya saja-saja taknak pergi Kuantan. Temerloh driver boleh hantar dalam 20 minit je in sha Allah dah sampai. Kuantan nak lalu jalan Gambang lagi, dengan lori lagi. Kita nak cepat nak selamatkan nyawa makcik.
Grandson: Tak payah la doktor. Kami dah bincang bawak je dia ke Kuantan. Saya banyak kerja ni. Susah la kalau dia ke Temerloh. Sapa nak jaga.
Me: Itu kita pikir nanti la, encik. Sekarang yang penting kena selamatkan nyawa dia. Nanti bila dia dah stabil kat Temerloh encik mintak transfer la ke Kuantan.
Grandson: Tak. Muktamad. Kuantan. Saya kerja.
Me: Saya bagi MC untuk esok. Encik settlekan masalah tempat kerja. Sekarang ni fikir yang terbaik untuk nenek encik.
Grandson: Kita dah fikirlah ni. Nak ke Kuantan je.
Me: Encik faham tak, risiko kalau pergi jauh2. Dia kegagalan jantung. Bila-bila masa jantung dia boleh berhenti.
Grandson: Biarlah jantung dia berhenti!
Me: (I lost my cool at this moment). Cuba jangan pentingkan diri! Saya nak encik ingat kata-kata encik sampai bila-bila, agar bila encik tua nanti, anak encik cakap benda yang sama dekat encik, baru encik rasa.
Grandson: (silence).

So yeah, I kurang hajar to the patient’s kin. Did I regret it? Nah. Am I afraid if he would file a complaint? Be my guest.

I asked him to document that he would take the risk of any unfortunate event (including asystole) that were to happen to his grandmother due to his request for Kuantan referral. He took his time writing down, he struggled with the spelling. It’s okay if you are illiterate. What’s not okay is how eff-ed up in the head you are.

I told my driver and SN to pick up the pace and slam a foot on the pedal. So public, please know, because of his arrogance, I had to put my driver and staff nurse’s lives in danger.

Alhamdulillah, makcik arrived in one piece, but I really hope she amended her will soon.

Drama swasta wrapped up around 1 am. So I went back home for a dreamless sleep. Woke up at 635 am (yes I subuh dinosaur here) from another phone call. This time MA Zana’s voice was of despair mixed with sleepiness. 50 something year-old Indian lady, brought in by family members for being unconscious. Son claimed she complained of chest pain and shortness of breath before falling unconscious. Zana said, pulseless, tangan dah keras, pupils dah dilated. Sigh… I put on my jeans (thought about going to clinic in my funky sleep pants but nah…) and sped to the clinic.

I reconfirmed what Zana had already assessed, patient was brought in dead. She lived somewhere in Sri Jaya and that is like half an hour away. I shook my head regretfully and called it, and the children wailed some more. Daughter in-law asked me to reconsider my finding. One son kept on shaking dead mother’s shoulder, asking her to wake up. My heart went out for them. I looked at her record, aunty was recently discharged from ward for MI (serangan jantung, not mission impossible). I wrote the memo necessary for the death certificate and called for one of the sons.

Me: Sorry ya. Saya bagitahu sama you ya sekarang. Jantung dia sudah berhenti. Dan otak dia pun sudah mati. Sudah keras. You mari tengok mata dia saya tunjuk sama you. (Showed how pupils were already fixed and dilated). Itu bermakna otak dia pun sudah mati. Kalau jantung saja berhenti, kita boleh cuba kasi jantung dia start balik. Macam dalam TV tu kita kasi pam sama itu jantung dia.
Son: Jadi memang mak saya sudah takda la?
Me: Ya, memang sudah takda. Saya mintak maaf. Saya tahu you baru sambut tahun baru.
Son: Takpala doktor. Kita penat sembahyang kasi Tuhan, tapi dia takda tolong pun sama kita.
Me: Aiyo. Jangan macam tu. Saya harap you bersabar.

Son thanked me and just gave me a watery smile and left to the police station.

It marveled me how God was trying to teach me in stages. Two different scenarios. Two different outcomes. Two different lessons. I lost faith in my own race sometimes…

So where did we go wrong?

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