Saturday, April 5, 2008

Sometimes.




She came to me at 3 a.m in the General Surgery Ward.

Jenny was a 27-year-old Catholic Filipino lady. She married a Sabahan Chinese after coming to Malaysia with a valid working permit a few years earlier. The couple would go on to have 4 children. Her husband was a promiscuous character and...


Sometimes

She came to me at 3 a.m in the General Surgery Ward.

In order to protect her confidentiality and the privacy of her family, I’ll refer to her as Jenny. In all likelihood, none of her family members read blogs and similarly, most blog readers will not know her family. Regardless.

Jenny was a 27-year-old Catholic Filipino lady. She married a Sabahan Chinese after coming to Malaysia with a valid working permit a few years earlier. The couple would go on to have 4 children. Her husband was a promiscuous character and for the last three years, had gone ‘mengembara’. It was much when I found out that ‘mengembara’ was her way of saying that her husband had died from an undisclosed illness while searching for a job in Peninsular Malaysia. To make ends meet, Jenny worked in an oil palm plantation in Lahad Datu, about 6 hours by car from Kota Kinabalu. The task of supporting her young children became much more daunting after her husband’s death. When she became too weak to work any more, she knew it was time to seek medical help despite financial constraints.

The first medical officer who saw her in the casualty had performed a preliminary evaluation and decided to admit her. I took a glance at his notes from the casualty department. In typical doctors’ illegible handwriting, he scribbled a brief medical history and diagnosed acute appendicitis.

By the time I attended to Jenny, it was already around 4 a.m. She had been ill for almost eight months, feeling weak and lethargic. She had consulted a family physician back in Lahad Datu. Apart from vitamins and health supplements, she was given no further treatment or follow up. Dissatisfied, she went to a health lab herself and got the usual ‘package’ of investigations. She was subsequently told to have Hepatitis B with no further advice or follow up tests.

When her general health deteriorated further, she went to Hospital Lahad Datu to seek treatment where the doctors ran a barrage of tests and found her to be anemic with an enlarged liver. She was given a blood transfusion and underwent CT scan of the abdomen which revealed a solid lesion in the liver. For some reason, she was discharged without further management. She had been in increasingly severe pain since then.

I asked Jenny why she chose to come to Kota Kinabalu at 3 a.m in the morning when she had already been ill for eight long months. She had no transport and had waited for almost 12 hours before a kind Samaritan in Lahad Datu agreed to give her a free ride. Jenny apologized for disrupting my sleep which was appeared increasingly evasive that Saturday night/morning.

Sleep was not my main concern that night. This was not a patient with 3 years of perianal itch coming to seek treatment in the wee hours of the morning. Before me that night was a very ill lady in a truly desperate situation after the healthcare providers failed her again and again.

Jenny was in great pain when I saw her that night. Nevertheless, between labored breaths and a spiking temperature, she gave a vivid and specific account of the chronology of her illness – no anu bah, no vague descriptions and no lies. She had enough wisdom to bring along all her medications and CT films, which really aided my clinical evaluation.

By the time I examined her thoroughly, it was clear that there was no way she was having acute appendicitis.

Jenny had a huge liver abscess, with a background of Hepatitis B and advance HIV/AIDS.

As tactfully as I could, I told Jenny the truth. She remained calm and composed.

I took the necessary blood investigations, administered antibiotics and ensured adequate pain relief and hydration before retiring for the night. It was 5 a.m by the time I was done.

I took care of Jenny over the next few days. While awaiting blood results that took eternity to return, she was sent for a scope which revealed a large tumor in her stomach. It was probably HIV-related lymphoma of the stomach. A repeat ultrasound was done and unsurprisingly, the lesion in her liver was enlarging. From Jenny’s medical history, I was certain that the lesion was an abscess rather than a cancer, but the attending surgeons disagreed. They sent her off to the medical team for further management in view that there were no plans for any surgical interventions.

Before she was transferred out, Jenny asked for me and told me something I probably will never forget.

“Doktor, saya tau saya tak akan hidup lama. Walaupun saya akan mati tak lama lagi, saya sangat terima kasih dengan kamu sebab sekarang saya sudah ada jawapan sebelum saya pergi mengembara. Saya tak ada cara untuk balas jasa tapi saya akan berdoa untuk kamu.”

(Doctor, I know my time is up. Although I will die not long from now, I am very thankful to you because at least now I have answer before I move on. I have no means to repay you but I will pray for you.)

I kept mum.

Here was a single mother in a foreign land married to a Chinese Malaysian. Life should have been better and more stable after marrying a local man. Instead, she inherited no money or assets from her promiscuous late husband but deadly diseases and years of physical and emotional suffering. She was a lady who had traveled far and wide from a rural district after being let down by doctors time and again only to be told here in KK that she was dying from a disease that she did not bring upon herself. She was totally uneducated but had enough insight to know that she needed professional help. She was physically weak and drained, but emotionally strong and determined regardless of the inconveniences she may go through and the rejection that she may face. She had no parents or proper schooling, but took great care to remain courteous even as death beckoned. Despite being in full awareness that her condition was terminal, she was unwilling to simply fade away without an answer and a dignified departure.

Sometimes, that’s really all that matters. In so many circumstances, patients and families and loved ones are not expecting doctors to play God and work up wondrous miracles.

Sometimes, all they need is an answer - an answer to their many angry emotions and intrusive questions that linger on after the death of a loved one.

Sometimes, the bitter truth brings more healing than a cocktail of drugs. One allows closure to a sad chapter of one’s life. The other may be nothing more than fat jargon in the closing chapters of a pharmacology textbook.

Sometimes, honest answers are less disappointing than failed heroic surgeries.


I checked on Jenny a week after she was transferred out of the Surgical Ward.

She died the night before.

The medical team had re-evaluated Jenny’s condition especially the indeterminate mass in her liver. It was a liver abscess after all. The abscess was drained and gave out almost a litre of pus.

Jenny succumbed to complications of HIV/AIDS anyhow.

Rest well, Jenny.

Thank you for leaving a mark in this doctor’s life too.

9 comments:

dahvid said...

Thanks for sharing this touching story...

Sometimes I wonder how people can still cling on to their humanity despite suffering so much. :/ Jenny was indeed a strong lady.

fooji said...

this must have happenned during your surgical posting. I am in total agreement, that honest, thorough explanation should be given to patients and their concerned ones, instead of rushing things through.
I hope the new minister understands that sometimes we take a long time in the wards and in clinics because we want to explain things properly, and not just some business gimmick of only 30 minute waiting time.

Can i propose that your story be in the prescribed reading for innocent young medical students?

Fooji

Anonymous said...

god bless you bro

Anonymous said...

Abominable!

This poignant tale has been an utterly disconcerting and discomforting read. It’s a pity that by the time she got round to seeing you she was already at death’s door staring death in the eye.

I went through a whole gamut of emotions reading today’s blog post. Suffice to say I am appalled, aghast and aggrieved. One cannot help but despair about this sorry state of affair.

It appears that life really is cheap for the destitute and the seriously disadvantaged.

I am all but certain that the outcome would have been very different if a well-heeled or influential patient with a lot of clout suffered from the same medical condition.

It is common knowledge that timely and appropriate medical intervention goes a long way in alleviating unpleasant symptoms thus improving quality of life. It also helps keep death at bay.

Not only was she given the runaround by the less than judicious healthcare professionals, nonchalance seems to be the order of the day. Not only that, careless disregard for a patient’s well being is also par for the course.

Is empathy such a difficult concept to grasp or are they so inured to despair, desperation and desolation that patients are no longer regarded as human beings with feelings but just another statistic?

“When her general health deteriorated further, she went to Hospital Lahad Datu to seek treatment where the doctors ran a barrage of tests and found her to be anemic with an enlarged liver. She was given a blood transfusion and underwent CT scan of the abdomen which revealed a solid lesion in the liver. For some reason, she was discharged without further management.”

“From Jenny’s medical history, I was certain that the lesion was an abscess rather than a cancer, but the attending surgeons disagreed. They sent her off to the medical team for further management in view that there were no plans for any surgical interventions.”

Reading that makes one wonder if they
a) had they been remiss in discharging their duties? and
b) isn’t there room for redress if indeed there has been a dereliction of duty?

Pardon me if I’m wrong. It sure sounds like the standard of healthcare for those who are on the edge of an abyss is well and truly abysmal. Tis a sorry state of affair!


Q8-)
Your kindred spirit

Anonymous said...

did you asked about the kids? fair enough, the mom's gone, but the kids are still alive, no?

jedyoong said...

that's terrible. would an operation have saved her? gosh.

just brings back memories of my granny in UH. the doctors din want to operate. really pissed off. terrible stuff.

zewt said...

i guess she would rather go than to be a burden for the family. and most importantly, you have saved a life... you saved her... from a different perspective.

if only all docs are like u.

psc said...

God Bless You
i too worked in kk many years ago from my experinces there,the patients there are very humble greatful for the treatment given to them.i enjoyed woking in kk and sandakan.to all my friends in kk.God Bless you all

sojourner said...

hey, i remembered you introducing me to jenny. she was one of the few 'foreigner' that you actually didn't scold despite waking you up at 3am. and i really commend you for the effort you put in to help her. to have her told you the things she told you, she must have trusted you a lot and must have been really really grateful that a doctor actually cared for her.
i still remember your frustration over the surgery ppl transferring her to medical. and that you actually made sure you settled her case before the transfer.
perhaps she'll be another of the 5 ppl you meet in heaven. i guess then you will see her in Daddy's bosom glowing pink in health, nothing like how she looked like in her frail earthly body. God bless her soul..and yours too...