I babble, I ramble, and I rattle

First of all, I would like to convey my condolences especially to my aunt, Cik Maz (and also to her family) who lost her father, Dr Anuar Nor Arai on 20/1/2010 (read HERE). I attended the prayer rites on the evening of his death… And it was my first time ever attending such a function. I was not able to attend the funeral as I was on call on that day.

I had not lost anyone dear to me yet. The only time it came close to that was in 1995 when Mok, my great grandmother passed away on the day before the day I was to be announced as the best student in my school. I was too upset on that day to feel much sadness with the loss. Mama was away studying in the UK and Ba’ah had to go back to Kelantan for the funeral. Only my uncle (Cik Maz’s husband) could make it to the function and take pictures of me collecting the awards (as well as Boka and Yi who also won several prizes themselves). However, reality sank in after all the celebration in school and I did finally cry that night. I did love Mok and she was gone.

It was a sad occasion that day at Cik Maz’s parents’ house. It felt really weird as I’ve only been there on happy occasions – e.g. wedding receptions, birthday parties, raya open houses, etc. I managed to not cry but a few drops of tears did escape the moment I saw his face. He didn’t look any different from when he was alive.

I was well aware that he was a well known person in the entertainment field (after all, I did see a number of celebrities at Cik Maz’s wedding reception) but I never knew what he did exactly. Some time last year, Cik Maz invited me to watch her father’s latest theatre, Ronggeng Rokiah with her and her students but I was unable to join them due to work commitments. I also didn’t know Tok Selampit was written by him but that title is very familiar to me (though I can’t recall if I’ve actually read it).

Nevertheless, I would always remember him as the joyful uncle who loved to tease Kona when she was small.

May he rest in peace. Al-fatihah…

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Basically, this past week had been a week with many deaths for me. There was a case of a 19 year old boy who went asystole (i.e. dead) as soon as he reached the ward. We did CPR like crazy and managed to save him… for only another 4 hours. The problem was… He already had a heart valve replacement done a few years back but he defaulted his warfarin therapy. When he came in to our hospital, there was a huge blood clot sitting in his heart, causing its failure.

It was also the week when I survived 36 hours of non stop work and 4 CPRs with only 10 minutes of sleep (managed to take a short nap during lunch hour). I wonder how I survived that day… But I did. Needless to say, I was caught sleeping while standing up twice.

That day my ward had 4 patients on ventilators (the ICU proper has 16 beds; hence the joke – by our ward members and ICU staff – that our ward had turned into a mini ICU). When we intubated the 4th patient, ICU people warned us, “That is our last ventilator (apart from those being used in the ICU). Please don’t ask for another one.”

2 cases caught us by surprise.

Case 1

A Malay gentleman in his mid 40s who only seeked medical attention after having multiple neck swellings for 1-2 months. Biopsy was done and sent urgently to 2 sources – a private lab and the usual government lab (our lab doesn’t read biopsy samples and would send the samples to another government hospital lab). You will get the result faster with a private lab but it is not always very reliable. The government lab is more reliable but it might take some time before you get your result.

Anyway, the private lab result came back as lymphoma and the patient was urgently admitted to my ward. He was very well on the day of admission (he had no complaints whatsoever). But within the next 48 hours he deteriorated rapidly we could not catch up with the disease progression. His kidneys failed and he was bleeding profusely due to his deranged blood components which failed to normalise despite continuous transfusions with blood products.

2 hours after his death, we received report that he actually had myeloid sarcoma.

He has 3 children, the youngest being 4 years old.

Case 2

A Chinese gentleman in his mid 60s who was only discharged from our ward last week for congestive heart failure. We drained about 21 litres of fluid from him during previous admission and he actually came back within 5 days because of shortness of breath. On the third day of admission, he was still comfortably talking to us (no more shortness of breath) but during lunch hour (about 3 hours later), one of the nurses noticed that he was sitting quietly on his chair, not breathing. She immediately put him on cardiac monitor and what came out was a straight line. We commenced CPR immediately and managed to bring him back. However, he was not doing well as we had to support his blood pressure and ventilate him. He passed away the following evening.

It made me wonder about our CPR. If he had been at home at that time, he would probably had died in peace. I didn’t think we saved him. I think we simply delayed his death by 24 hours and hence prolonging his suffering. On the other hamd, it was probably good that we managed to delay it (even if it was only for 24 hours) because at least his family would be (psychologically) more prepared for his departure.

He only has one daughter who is now 12 years old.

That reminds me of another patient I recently saw in the ward. He was admitted for symptomatic anemia (his only complaint was lethargy and we discovered that his haemoglobin level was 1/3 of a normal person). He had no other illnesses. After we transfused him blood products, he was very well in the ward. Being an educated retired policeman, he was a very polished gentleman who does everything in a very prim and proper way; hence the reason why I remember him so well. He was planned for colonoscope and OGDS the week following his discharge. To make things more interesting, he forgot to take the laxative home with him so I called the family a few days prior to the scope appointment day.  That was how I discovered that he had passed away just the night before.

Enough with deaths. Ba’ah and Mama are now in China for their first holiday in 2010. This picture is so cute I could not resist publishing it here.

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