Tuesday, July 7, 2009

Another escort session....

I had to escort another patient to SMC ICU again today...it was a planned transfer and the patient wasn't as unstable as the one yesterday...and as expected, boss happily dictated that i would be the one escorting this patient, despite the fact that there was a peripheral MO who should be doing all the escorts....in fact, there was a peripheral MO yesterday but boss didn't make her escort the patient.. and when i was doing periphery in Queen, boss made me escort all the patients who needed escorting....i should change my job description...it should no longer be medical officer...instead it should be 'high-class escort'!!!! no wonder i don't get any job satisfaction lately...

So i escorted another patient to SMC ICU yet again...and the boss there commented...you again??!! yea, that's right...me again....and he said i kept escorting bloody patients...like in the literal sense...coz this patient today also has some bleeding problem...anyway, the transfer took 1 1/2 hours...not too bad compared to yesterday...and i got back to the hospital about 5pm something...then left for home...yay!!!

On another note, there was a patient who was admitted yesterday...a 50 something year-old Chinese man who had severe community acquired pneumonia....he had been having some respiratory symptoms for 10 days prior to admission...he went to casualty on Sunday but he was sent home and referred to a government clinic for TB workout despite the chest x-ray showing very bad lungs...so yesterday, when he went to the clinic, he was referred again to Queen for admission...by the time the GA MO on call saw him in the ward (and he was just passing by the ward), the uncle was so hypoxic that his oxygen saturation on nasal prong 2L/min was about 50% and on high flow mask 15L/min was only 70-80%...

So the GA MO on call decided to intubate the patient and bring him into ICU...unfortunately his wife wasn't too prepared for his unexpected deterioration...and she told the MO that if she knew he was going to go downhill so suddenly and needed intubation, she would have asked for some time to have some 'last' words with her husband...anyway, the uncle died this morning while we were doing rounds...his lungs were so bad that he couldn't be oxygenated...and then his blood pressure dropped probably due to a combination of sepsis and hypoxia, requiring maximal inotropic support...when i told the wife that his heart has stopped, i think it took quite a while for her to register the fact...and she kept asking, why so sudden? is he really dead?...and she cried and cried...the uncle's daughter (who was studying in Singapore) didn't manage to come back in time to see her father before he died...by the time she reached the hospital, her father had moved on...

It's so sad...his death was quite preventable, if treated earlier....in this era, in this country, and in a city, i just don't think it's acceptable for someone to die of pneumonia...or post-partum haemorrhage, TB, malaria, dengue and many other treatable diseases for that matter...it would be a different matter if he was in the middle of the Amazon jungle with no immediate access to medical care...i messaged the post call MO and told him that the uncle died...and his reply was, guess God doesn't heal anymore huh?...sigh...it's so hard to keep the faith when day in and day out, your work life keeps throwing 'shit' at you....somehow you can't help but start doubting...it's not that i don't believe in miracle...i do.. the fact that my patient J is still alive till now (and he probably survived his op) is a miracle...but somehow it doesn't seem to happen often enough huh?

Oh well, tomorrow i'm doing periphery...and there's no ICU MO in-charge...guess i'll be the escort again, if an escort is needed...which usually is the case...uughh!!!


  1. Is the doctor at casualty another unqualified A**hole?? Basically the late uncle had been suffering from pneumonia for almost 2 weeks. My God!!! How can any doctor miss out something like pneumonia? Didn't he auscultate the patient? The doctor cannot interpret the CXR ah?? Does the doctor know how a TB lung look like? And he/she call him/herself a doctor?

    Reminds me of one of my young patients who died of destructive pneumonia (at autopsy, both his lungs had so many pus-filled abscesses that we couldn't even see any area of healthy lung tissue!), except that time, it was his own mother, an ENT specialist, who treated her own son. When her son's 'FLU' didn't go away after 2 weeks, she brought him to a physician who ordered a chest X-ray and by then, the lungs were already badly damaged. Even the consultants who came to see him (yea, they couldn't do much for him already, we had used all the ABX that the sensitivity test showed +ve but his condition kept on deteriorating) were so shocked to see the CXR. The respiratory consultant did a pleural puncture to drain what was thought to be a pleural effusion but only blood drained out. His lungs was hemorrhaging....of course, the boy died and he was 2 months away from his 18th birthday or just passed his birthday, if I remember correctly!! He was a healthy boy with a very well-built body and active in sports!

    We are living in the 21st century and yet here we are, seeing patients died from something as treatable as pneumonia!!

  2. actually, the casualty MO saw the x-ray and noted the right bilobar pneumonia but i guess we'll never know why he did what he did...well, if your ENT sepcialist can misdiagnose her own son, then it's not surprising a casualty MO can send a patient with that bad a pneumonia home...

  3. Very difficult to say without clinically judging the patient. It could well be pulmonary TB or even lung metastasis/lung ca- very commmon misdiagnosis for pneumonia. Or one of those exotic pneumonitis/vasculitis.

    If it is suspected chronic pulmonary TB, in this part of the world it is not such a big deal. Most doctors("in this part of the world") would send stable patients home while awaiting sputum results, even though I think it is wrong.

    I think for vonvon's case, I'm sure the patient has been prescribed antibiotics by the mom. Even sinseh at pasar malam know how to prescribe antibiotics hehe. Maybe he has cystic fibrosis, some congenital bronchiectasis or some immunodeficiency syndrome.

    Sometimes even we have the best doctors to treat, patients will also die because of the limits medical knowledge. Even in the most advanced of countries, there is still significant pneumonia mortalities.

    Anyway with 21 medical schools in M'sia today, has anyone wonder where they find the teachers?

  4. yea jerome, he could have had underlying malignancy...but i guess we'll never know.. what exactly are you implying about the last question?

  5. Hey cheer up. Think of the patients that were managed to be saved rather than the ones who did not make it for whatever reason.

    I meant, how did all the medical schools get adequately qualified lecturers? For example, you can count with probably with 2 hands the number of neurologist in the country, so how did all the medical schools teach clinical neurology? So is it surprising if the graduates do not know much about neurology?

  6. i can't seem to recall any patients that i've saved..all my patients i admitted all end up dead or not doing too well...makes me start to doubt...
    i guess that's why we're hiring so many foreign lecturers..hehe...