Dealing with kids

I think great doctors are great because of their patients. Had it not been their patients, the medical profession wouldn't even have existed.

I always feel very thankful to the patients I come across. Although some may be a little bit annoying, especially the well-educated ones who think they know a lot about diseases when in actual fact they know very little, I guess I'll still be tolerant enough in future to respond to their hostility with a placatory smile. After all, as the Declaration of Geneva puts it, I'm supposed to consecrate my life to the service of humanity and practise my profession with conscience and dignity. And all these include having a lot of patience. 

But, I've seen spiteful doctors lose their temper and say awful things to patients. Such a scenario is commonplace in government hospitals overcrowded with the sick and needy. I'm not surprised at all, considering the the amount of stress they work under. Nonetheless, I still find the remark very imbecile and inconsiderate. Such doctors propagate a very negative image of others in the noble profession. Well, Savante may say I'm just another typical medical student full of idealism which may have no place in the actual working environment. But, we'll see how it goes. Meh.

And paediatrics is one of my most favourite subjects, partly because I get to deal with children. I find children very adorable, lovable and intriguing, though I still feel intimidated whenever I have to approach an inconsolable kid who cries incessantly even after having exhausted all the tricks I usually use to make my nephew smile. 

But then, when I do succeed in pacifying and soothing a fretful child, no words can describe the sense of achievement and satisfaction that floods me. When you tickle him, he lets out a chuckle followed by a few mumbled sentences of indecipherable words. And as you look into his eyes still glistening with tears and the dazzling smile that slowly forms on his angelic face, you suddenly realize the fatherly instincts you were born with. Haha. I know this might sound absurd. But, at least it applies to me, for a fraction of a second when the eye contact is established. Thereafter, you have to regain your composure and examine the kid competently and present your findings to a consultant who's scrutinizing your examination techniques.

I can still remember the face of the boy with beta-thalassaemia major whom I examined a few days ago. He had a facial expression with loneliness and sadness mingled. How can a kid deprived of quality of life and who has to receive frequent blood transfusions and live with all the debilitating effects the disease be happy and jovial? He looked very innocent, incapable of meanness, hypocrisy and selfishness, unlike the adult patients. I could see a fragility in him that cut through my heart. How I wish I had the power to enliven his gloomy life and lessen his sufferings.

Just for your information, I have alpha-thalassaemic trait. No. I'm not anaemic and I don't need blood transfusion. If I ever get married to a female carrier, each child of ours will have a 25% chance of having thalassaemia major, 50 % chance of being a carrier and 25 % chance of being normal. However, this piece of information is hardly relevant to you gays. =)

And if you ask me if I want to father a child someday in future, the answer is yes, although I don't quite see the possibility of it happening in this life. 

I cried

N.B.: Thalassaemia major is a genetic blood disorder that's very common in Sabah. The haemoglobin levels become very low due to increased red blood cell destruction, necessitating repeated blood transfusions for life prolongation. It's incurable and non-communicable. Thalassaemics don't live long. In the end, their hearts invariably fail.

He collapsed.

The doctor and nurses pumped in all sorts of drugs into his veins and did a cardiopulmonary resuscitation (CPR) to save him. His ECG reading was bizarre. Ventricular fibrillation ? An endotracheal intubation was done as he was unable to breathe spontaneously.

It's an emergency.

I could hear the hysterical cries of his mother as SL and I took turns to do the chest compressions.

He suffered from beta-thalassaemia major and had developed severe decompensated heart failure and acute pulmonary oedema. A few thalassaemic patients, whom he'd got acquainted to while being hospitalized, looked from afar, stunned and helpless. I guess the situation must have freaked them out, knowing that that's how their lives were going to end.

The doctor managed to stabilize him. But, I knew deep in my heart that his prognosis was bad. The nurses left him to fill up some forms. I guess there're some routine blood investigations to be done. I volunteered to do the bag ventilation for him as there's no mechanical ventilator in the ward.

Everyone left. I suspected the doctor had relinquished all hope in reviving him. I did the bagging patiently for the next 45 minutes. Who knows there might be a miracle? This sounds ridiculous, but it's an idealism all medical students are supposed to have.

I took a hard look at his almost lifeless body. His nasal bridge was depressed. His cheekbones and forehead were prominent and his liver was huge, all of which were due to extra-medullary haemopoiesis characteristic of the disease. Iron deposition secondary to repeated blood transfusions had put on a slate-grey coat upon his skin. He opened his eyes wide to stare at me thrice. A reflex that ached my heart.

Uncontrollably, tears welled up in my eyes. I didn't see that coming, seriously. I hastily dabbed my tears and pretended to wipe away the perspiration on my forehead when a staff nurse suddenly barged in.

He died in the A&E department half an hour later.

Miracles rarely happen.

They make the ward a beautiful place

As I draw near them, some of them pretend to sleep. Some of them give me a derisive smile and the please-fuck-off look upon learning the fact that I actually am just a student. Some of them appear to be delirious and uninterested without bothering to answer any of my questions. Some of them get fed up when I am already halfway doing the history taking. These, are what happen in the ward. It is typical of the patients to be impolite to medical students.

It hurts at times, to be scorned and treated with hostility. Really.

Nonetheless, there are patients who make me feel damn great about myself. They are people who guide me how to insert my 2 fingers into their vaginas, people who greet me with an encouraging smile despite my failure in taking their blood (by venipuncture), and dying patients with valvular heart disease who allow me to appreciate their cardiac murmurs…and so on.

I still remember that pleasant and friendly woman with cervical carcinoma in pregnancy who died 3 days after I took her history. I still remember that 46-year-old nulliparous woman with an ovarian mass the size of a football and whose malignancy had yet to be confirmed, that agreed without a second thought to become the subject for our bedside teaching. That warm and chatty lady immobilized by paraplegia in the orthopaedic ward. That amiable boy with atrial septal defect complicated by thalassaemia major in the medical ward.

These are people to whom I feel eternal gratitude and who make the ward a beautiful place I enjoy going.