Friday, November 21, 2014

Disease of the Heart




"Yesterday she came back to life..after having literally died for 10 minutes.
It was the scariest thing I've seen in my life!", 
said the staff nurse with a morbid sort of excitement, almost gleefully.

"Anyways, both of you can take her blood glucose reading", she said. 
It was music to the ears of my clinical partner and I - two typically UPSA-obsessed medical students.

"She is very poorly..she won't get better again. We are waiting for her son to fly in from America tomorrow morning to see her", she continued. 
("...for the last time", she could have added.)

So my clinical partner and I, armed with the blood glucose and ketone monitoring kit thingy, approached the bed of the lady who came back from the dead yesterday.
Around her machines beeped and sighed; as if lamenting the situation, as if grudgingly acknowledging the futility of the task they have been set up to do - to keep her in an artificial state of life.

Then again, was she really alive? 
I mean,
her brain is present..but her thoughts were most likely not.
Her lungs exchanging gases..but only with the persuasion of those sighing machines.
Her anatomy complete..but yet, very much like a piece of meat which though has not yet decomposed, is already past its date of expiry.

She lies down there asleep, never to wake up again; a living corpse.
She still exists, but I dare not say she is still alive.


If those thoughts were on my mind, I pushed them aside to focus on the task at hand 
as I took her hand, still warm (my hands ironically colder than those of a dying lady),
pricked her finger, and tried to coax a drop of blood out of her.

Bumbling medical student that I was, though, I tried and failed a few times - one time I would drop the sample collecter to the floor, on the next try the blood would stubbornly refuse to come out, etc etc.
The only comfort I could draw from the situation was that my clinical partner was just as clumsy.


As we struggled on incompetently by the patient, I noticed the staff nurse in conversation with another healthcare professional (the pharmacist?).
I no longer remember what they said - but what I recall was the cheerful nature of the chat.
It struck me as disrespectful somewhat: here was a lady who was about to die, at the very latest, in the next 48 hours (if she isn't already classed as dead) - but there you are chatting away like nothing of significance is going on!
This lady, lying prone on the bed, is a person - a human being was once upon a time born into this world, grew up with loved ones, probably went to school somewhere, went to work, fell in love, became a mother herself (maybe even a grandmother?).
God knows the joy and grief she went through in this experience called Life; and how, along that journey, she has touched the lives of those around her - her loved ones, her friends, her acquaintances, or even strangers.

To put it simply, this is a lady who has a life story..and we, in this ward, today, have received the honour of becoming part of the final chapter of that tale. 
It struck me as disrespectful
because of how matter-of-factly the nurse and the pharmacist(?) treated such a profound fact.


But then I took a look at myself
and saw a medical student 
struggling to get blood 
out of a dying lady's finger
just to get an UPSA signed off.

Who was I to talk about disrespect?

*          *          *

Later on a palliative care nurse spoke to my clinical 
partner and I.

What she said, I still remember - and could very well resonate throughout my medical career - 
as she questioned:

"What we are doing now - taking obs, sticking needles into thislady once every hour, blowing her up with IV fluid - is it really for the patient?

"or do we actually do this for our own benefit? For us healthcare professionals to feel like we are still able to do something..?"

*          *          *

In these past few weeks the PBL cases have been about diseases of the heart:
AF, CCF, ACS, MI, and the like.

But I've developed the feeling 
that the most horrifying (and possibly most dangerous)
disease of the heart
is when we - the doctors, nurses, and other healthcare professionals -
become numb to the passing on of our patients from this life to the next.

And my fear at this point of my training?
Is that this disease is taking root in my heart as well.


P.S. I do not deny that healthcare professionals have to 'build a shield around their hearts' in order to protect themselves from the emotional demands of this profession; in order to operate more professionally for the patient's benefit.

I just fear that we will go too far and stop caring; in a field where caring for others is the core of what we do.


P.P.S. We did not get the UPSA signed off that day - instead getting a telling off for taking nearly an hour to get blood glucose and ketone readings from the patient (in our defence, we were distracted by the palliative care nurse!) 


- dedicated to a patient who, at the time this is written, has likely already left this world for the next. 
Though I have inadvertently become only an insignificant part of the final chapter of your life story, 
you have become a significant part of this chapter of my life story: 
the chapter in which I try becoming a good doctor -



Tuesday, November 18, 2014

Islands



Allah has spread the 5 solat throughout the day
like paradise islands in this ocean called the Dunya -
so that at set times of the day
we can go ashore,
take refuge, take a break
before we continue the difficult swim
through the Dunya.

But instead we can't bear
to stay too long on these God-given islands
(Naudzubillah..maybe we don't even visit them!)
and prefer to stay all day in stormy waters.

Take a long hard look at your daily schedule:

Are the five daily prayers
a sanctuary from worldly concerns,
or merely 
just another appointment
to add to that busy schedule?
Just another event to be rushed through?

Enjoy your solat..
take it slow,
feed your spiritual needs;

you have nothing to lose but the anxiety in your heart.
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