Wednesday, April 23, 2008

Dr. Rikki



Not a word came from him. Not a movement did he make. The fringes of his blood-stained white coat fluttered in a mini-frenzy as the squeaking, jaded ceiling fans blew his way. Against the sun, his tiny frame casted a long and forceful shadow.


Dr. Rikki

Marked furrows were forming between his tired-looking eyes, his expression slowly transforming into a frown. The teeny hazel eyes strained against the scorching afternoon sun, consigning eventually into a vague squint. In the cramped and crowded medical ward, a neck and white coat was not exactly the ideal outfit. Sweat trickled slowly down his temples, coalescing finally into a pool that drenched his short-sleeved turquoise shirt. His black neck tie was oversized in proportion to his tiny frame, hanging a few inches after his rusted belt buckle.

I stood an arm’s length away, keeping mum, observing this senior doctor in deep, concerted attention. There was no smile upon his pimple-scarred face. He had sparse graying hair that was otherwise trimmed neatly to an inch’s length. This great man must be at least forty years old but it was also possible that years of striving and struggling to be the knowledgeable man he is today have aged him beyond his time.

Scrawny and thin, his hands stayed put in the side pockets of his black pants hanging a distance above his ankle, revealing a pair of holed black socks wretched from years of repetitive wear, wash and tear. There was no definite expression upon this overworked and underpaid Dusun doctor. His bent and hunched posture bore evidence to the years he must have spent silently and lonesomely burning the midnight oil in the noble hope of serving his community one day.

This was a day like any other. A young lady laid in her bed, breathless and exhausted from whatever was rocking her frail, ailing physical body. At the end of her bed stood the pensive doctor, deep in thought and away in a restricted zone of his own.

Not a word came from him. Not a movement did he make. The fringes of his blood-stained white coat fluttered in a mini-frenzy as the squeaking, jaded ceiling fans blew his way. Against the sun, his tiny frame casted a long and forceful shadow.

It is true then, what we medical students were taught in medical school. So much information could be gathered from a mere general inspection of a patient lying before us without the need of touching, pricking or prodding a distressed soul. I wondered what was going through his mind. If only I could get a sneak peak at the long list of probable diagnoses he was conceiving all by himself.

A few other doctors gathered nearby, around the patient, beside her but not at the bed’s end. They were young and well-built, both cheerful and nerdy, talkative and restless. How unbecoming of these junior doctors to be distracted and uninterested even as their consultant physician remained focused and unrelenting over the pitiable young lady.

The consultant brushed aside an irritating sweat droplet that had made its way into his left eye.

It was then that I saw his name: Dr. Rikki, a name that I will remember forevermore. The sound of cymbals and drum roll played ceremoniously in the back of my mind. Behold Dr. Rikki – the first consultant physician of this house officer’s budding career.

It was then that Dr. Sam broke the mellowed ambience. He was one of the three younger doctors surrounding the patient.

“So what do you think Dr. Rikki? Do you think the sodium level in this patient is normal?”

?????

Now, wait a minute. Did that medical officer just posed a daring challenge to his consultant specialist, in a very rude manner nonetheless?

Dr. Rikki remained silent, his authority and wisdom under siege from a subordinate unaware of his rightful position.

“Dr. Rikki, if you don’t know the normal sodium levels, you can refer to the reference figures attached with the blood results,” Dr. Sam persisted, handling Dr. Rikki the patient’s charts.

I almost fell back to the ground in shock. Like a fool, I’ve been looking up to the wrong figure among the crowd. I have mistaken a fellow house officer for a consultant specialist.

The drumroll in my mind ceased abruptly, the cymbals came to a crashing halt.

Dr. Rikki (not his true name) remained interesting and enigmatic though, but mostly for very different reasons. As I worked with him or rather worked him out, I discovered a wealth of incredulous enlightenment, if I were right to deem it as such.

Dr. Rikki was indeed forty something years old. An indigenous local Sabahan, he was sent on MARA scholarship to Indonesia to study medicine, in spite of the fact that he never did apply for medicine or was ever interested in medicine in the first place. He went anyhow, and stayed a duration exceeding twenty years. He failed his first medical school, attempted to return but was pushed by MARA to complete his medical degree in another Indonesian medical school. It was then that he fell in love and married an Indonesian Chinese. The couple would go on to have four children – in Indonesia. As the responsibilities of fatherhood mounted, the then MARA scholar Rikki took an extended break from medical school to raise his brood. A man’s gotta do what a man’s gotta do, even if it was at the expense of Malaysian taxpayers’ money. He remained under MARA scholarship until the day he finally graduated with a medical degree from Indonesia – fifteen years later. He did not immediately return to Sabah though. The newly bestowed Dr. Rikki stayed behind in Indonesia for another few years. Only God Almighty will know what he was doing there.

Over the next few months of working with Dr. Rikki, it was obvious that he was pursuing all things but medicine all those years in Indonesia.

He made ridiculous clinical errors that will go down in hospital records as urban legends.

He discharged a patient with intravenous medications. The bent old lady came back to me with two boxes of bottles and drips but no tablets or pills.

He sent a patient with active tuberculosis home with all the goodies of vitamins, iron and double calcium supplements, but no anti-TB medication.

He started a drip regime for a patient in sepsis: three pints of normal saline and two pints of ceftazidime. What was he thinking, a life-long prevention of melliodosis infection?

A stroke patient was started on tube feeding. Most doctors will start slow say, at 500mls/day. Dr. Rikki started slow too, at 2mls/day.

His English was incredible, in a very absurd manner. Like advance kindergarten teachers, we taught him how to spell A-O-R-T-A and A-S-T-H-M-A, dictating each alphabet to him. Our blood pressure was rising faster the price of oil per barrel in USD.

When a lactating mother assured us she was breastfeeding well, Dr. Rikki scribbled in the notes: Mother says breast is well.

We all need amusement in our daily work, but not when it’s dangerously funny. I thank Dr. Rikki for all that and more.

I do not have any idea where Dr. Rikki is now. It would be interesting to know though. He’s definitely not in the hospital anymore. Rumors are that he left to pursue farming in Papar. Others say he was sent back to medical school (again!).

I may sound judgmental and holier-than-thou in writing the truth about him. Seriously, I don’t blame him for being slow, I blame him for wasting my father’s taxes and for being unwilling to improve and learn on the job despite the repeated chances.

What’s my point in writing this article?

Amongst others, some of which are stating the obvious:

• First impressions are deceiving. I felt like a fool after that first meeting in the ward.

• The BN government has wasted enough of our money handling out scholarships by ethnicity.

• Sabahans won’t necessarily treat Sabahans better. So stop this crap about work permits for Peninsular Malaysians when Filipinos are entering the state in sampan-loads every day.

• Tertiary education is not in the best interest of every person. Some are better off owning a farm in Papar, to sell papayas and become rich.

• Our Ministry of Health is full of hot air each time it speaks about quality control. Dr. Rikki worked for 18 months before the Ministry decided to take remedial action. If he saw just three patients per day, he would have endangered the lives of 3X30X18 = 1620 patients. Any one of them could have been your father and my grandmother.

• Possessing a medical degree is not reflective of anyone’s grey matter. It is true that empty vessels make the most noise, but not always. It is also true that diam-diam ubi berisi, but not always too.

11 comments:

Anonymous said...

One cannot make a silk purse out of a sow's ear.

Like a fish out of water, Dr Rikki was so out of his element he was floundering.

His silence was not quiet contemplation, it was quite something else. He wasn't studiously contemplating what line of action will best serve the patient at all. My guess is he was probably wondering how best to extricate himself from a tricky situation.

It didn't help that Dr Sam who must by then been hot under the collar was breathing down his neck, not wanting to let him off the hook.

Quote
"Others say he was sent back to medical school (again!)."
Unquote

Good grief. What kind of logic is this? Defies explanation. If he or the powers that be think he can make it as a doctor then pigs might fly.

Quote
"I may sound judgmental and holier-than-thou in writing the truth about him."
Unquote
Good heavens No. How can one be accused of being sanctimonious when one is merely stating a fact?

Dr Rikki is what Winston Churchill might call a riddle, wrapped in a mystery, inside an enigma.

Q8-) Perplexed kindred spirit

siang said...

This is a really funny article. But i would also like to share a true story.

There a houseman in my hospital that rumour has it that he is under some psychiatrist follow up. However, we cannot comfirm it.

One day, we were hanging around the counter chatting and gossiping. All of a sudden a staff nurse say that she was offer a can of beer by that particular HO when he was on call. He even told the staff nurse that he need beer during his call to keep him alert.

Now there is a rumour that he will be coming to my department soon.

God help us all...

mo_km said...

i thought he went to KL for another year of probational HOship ?

Anonymous said...

I cannot help myself but to laugh my lungs out after reading this article. However, i cannot believe that this kind of doctors exist. Poor that man, MARA really screwed his life.

the cili padi doctor @ Lynette said...

again, your witty stories are priceless. I have worked with numerous house officers, esp those who are much older & from God-khows-where foreign uni and seriously, age doesn't mean wisdom and competency at all.

a few of my housemen almost killed patients directly..thank God I do rounds 3 times a day and we often spotted their mistakes!

I shudder to think what some of them can do to the population in bigger hospitals where there are limited supervision by seniors due to the heavy workload. sigh....

dytia said...

siang - are you happen to be in seremban?

one of my houseman who are like that we reported him to KKM and instead of deregistering him - they extend him to do his housemanship elsehere.
From Temerloh he went to seremban last I heard.. Happy for myself as I no longer needed to babysit him but I pity seremban ppl.

to the blogger.. it's not holier than thou.. we are just stating the facts€.. sometimes some ppl are not really suppose to do medicine in the first place

CK Tan said...

POTS, I linked ur articles on Project IC to the post I did. Let me know if you want me to remove the link.

Anonymous said...

haha the longest hseman in medical dept ever!! since we were hseman he's like 1 yr there odi...still got special call for him?

kve said...

hi POTS.... sometimes i pity those fellows. they would have been better off doing something else.

siang..... are you from ipoh? there's one weirdo perverted HO who did exactly that.... offer a staff nurse beer when he was oncall.

Product of the System said...

Hi Kve,
Great to hear from you.
Hope we've both mellowed down since our student days.

Thanks for reading.

Keep in touch.

lifeinside said...

this is the time when indonesian doctors are supposed to be blamed.