What Does Hope Really Look Like?

Hope is an optimistic state of mind based on an expectation of positive outcomes with respect to events and circumstances in one's life or the world at large. (Wikipedia)

Today I had an opportunity to chat with another long standing patient in my ward. She was diagnosed with cervical cancer last year. Managed to get chemotherapy and radiation. However, her disease progressed. She is now receiving palliative care from us. She has a little bit unusual presentation as compared to others. In short she is now having difficulty in breathing, she needs those machines to support her.

Despite being told that she will be in her current condition and her condition may only deteriorates, she is still hoping that she will recover. She told me, she also wants to be like others, she doesn't want to be bed-bound. I asked her, is there anything else you want or wish to do? She said she wants to see her kids graduate. She said she hopes that she will recover real soon. 

She then asked me, where is Kakak K. She discharged home already? I was reluctant to answer. At last, I said yes, she was discharged home already. Little did she know that, she was discharged to another place already.

Maybe living with hopes is better than knowing that there is no hope anymore.

The irony is, cervical cancer is often curable if it was diagnosed at an early stage.

For in hope we were saved. Now hope that is seen is not hope, because who hopes for what he sees? But if we hope for what we do not see, we eagerly wait for it with endurance. (Romans 8:24-25, NET)

There goes my last 4 months rotation in gynecological ward. 

The Wilted Roses

This 35 years old lady, with underlying cervical cancer with disease progression was a regular customer in our ward. Her condition were not good. She had a mum and a brother. Brother was already married, their father left them for another women. This patient, Ms S preferred to stay in the hospital. Her condition was not good and she was not fit for the palliative chemotherapy.

She was the one:

1. whom I arranged her to SGH, Kuching previously. (end of last year)
2. whom she wished to have a life like other normal person.
3. whom she saw me came out from my oncall room after taking my shower, and told me that how she wished to be able to take a shower. (she was bed-bound and her mother wiped her body and changed her pampers everyday).

Sometimes, patients ask questions or give statement which will pierce through your heart.

Her condition deteriorated day by day, we kept her in the ward, giving the best supportive care that we could including IV drips, painkiller etc.

One day I decided to buy her a bouquet of roses. To my surprise, she broke into tears when she received the flowers. Her mother helped her to put the flower in an empty bottle, and her mother watered the flower 3 times in a day. But roses wilted after a week. I managed to quietly changed her roses on weekly basis. Managed to change 3 times in total. At last, during my oncall, her condition further worsen and at last, she left all of us. I signed her death certificate. Before this, I didn't see anyone came to hospital to visit her, except for her mum, sat by her side everyday and took good care of her. However, when she passed away, some unfamiliar faces turned up.

Some people questioned me that, why I bought her flowers instead of giving her money to buy some good food for her. I don't know. I am happy when I see flowers. I hope she will be happy as well by receiving the flowers. My wish is just to add a little bit of happiness for her. I don't know what else can I do for her. She had junk food and kuih raya beside her bed but she had no appetite at all.

At last, the roses wilted forever, no more replacement, unable to be revived.

It is the same with our life.....please live your life to the fullest, and above all, appreciate those around you, those who helped and loved you. Especially those who helped you even when they themselves are struggling, because they really love you.

My last oncall on 16th August 2019, I admitted another cervical cancer patient with disease progression. Her bowel obstructed and became distended. Her kidneys are in bad condition. She is 41 years old. She asked me is there any hope to cure? Her son(adopted) is only 1 year 9 months old and he is waiting for her at home. How did I answer her? What did I say to her?

Friendship

We were strangers, on a crazy adventure,

Never knowing, we will meet at a crossroad,

Never knowing, what we'd have go through.

And here we are,

In your hardship,

You are looking for a new life,

In my ordinary days,

I am still in search of the past.

And at the crossroad,

You guided and helped the inexperienced me,

In my mistake, you stood up for damage control,

At times, you motivated and inspired me,

When I lost hope,

You were there to remind me.

We talked, we cried and we laughed,

You welcomed me into your journey,

I found someone there,

I see the journey of the most important lady in my life.

And there we are,

Had a little smell of the river,

A blow by the cool evening breeze,

Listened to the whisper of the heart,

Walking down the riverside.

Love is beauty, love is pure,

Love pays no mind to desolation,

It flows like a river through the soul. 

How does a moment last forever?

How can a story never die?

In this precious and priceless moment, 

Somehow, our time and place, stand still.

5th July, 2019 at 2235H

the little Angel left us

2 months ago. I saw a patient in labour room, she was in tears worrying about her pregnancy. She was told by the private doctor that her baby stopped growing. After my assessment, she needs a frequent follow up under us and she may need imminent delivery at any point of time. Her baby stopped growing for the past 2 weeks. Detailed scan done by 3 specialists showed a grossly normal baby.

It didn't last for even a week, she underwent an emergency operation. On the next day, I was shocked to receive a phone call from a group of friends, telling me that both couples were crying. I was on my way back from lunch, rushed to SCN (where their baby was admitted), I was taken back by the news. The baby is likely to be Patau Syndrome.

I straightaway went and met the patient. She was in tears, and for the very first time, I cried as well in front of my patient. I couldn't hold my tears. My heart was torn. After arranging them to a special room behind, I left. I still need to go to the combine clinic. On and off, I still burst into tears. I was seeing the combine clinic patients asking how are they doing but inside my heart there was an indescribable feelings. My heart is aching.

Days passed, everyday I would pay her and the baby a visit even when she was transferred to the NICU (neonatal ICU). She was there spending her time with the baby. I could see her eyes swollen, very swollen. She must be crying everyday. During my oncall, when the ward was not busy, I will go and visit her and have a chat with her. I always believe that companion is better than all those comforting words.

There's one Saturday afternoon when I planned to go to a church activity, but I ended up in hospital because I was late for the church activity. To my surprise, the baby was intubated. Things didn't seem alright. Not long after that, she left us.

I remembered when I was oncall, whenever I was free(usually about 2-3 am), I will spend time with the baby in NICU. I can see that she was so lonely. I talked to her. She was strong, she survived long enough for her condition. She is an angel, that I will never ever forget. I wish to see her again in heaven. The sadness is indescribable, and I believed the mother had so much more to bear. It is not easy. I won’t ask her to walk out of the dark shadow, but I prayed that she will move on with the scar.

Most of the time people will blame the mother for what has happened to the baby. And that is the most common question asked by patients. I told the her, it wasn’t her fault that the baby ended up with Patau Syndrome.

p/s: permission granted from the patient for this post

Every baby is a Gift

I was oncall on 5th October 2018. We have one patient with second trimester loss (means that the mother gave birth to a dead baby at early stage of her pregnancy). The baby might be few hundreds grams only and they are born dead.

The patient was only at her 18-20 weeks of pregnancy when she delivered the baby. One of my gazetting specialist came to the hospital for a medicolegal case examination and she got to know that the patient had already delivered the baby.

She asked me: "..., normally where did they put the fetus(baby) ya?"
Without thinking any further, I answered: "Likely in the yellow plastic bag".

I feel weird towards the question that she asked. However, I never think about that. For adults, when they passed away, we have the metal coffin-like place to put/transport the corpse temporarily, but how about the fetus(baby) which is only 300 grams?

So I went and found out that the corpse of the baby will be put into a proper box and will be transported to the mortuary. Not in the yellow plastic.

I updated the specialist via whatsapp.

She replied: Every baby is a gift.

Some baby might not make it to live in this world. Some might passed away early due to chromosomal or structural abnormalities. But, they are still a gift. Every baby is a gift and we should handle them well.

Friends for a season

I was in-charged of antenatal ward for the past 4 months.

There were one group of patients who were admitted to the ward for placenta praevia. Placenta praevia is a condition whereby the placenta is located at the lower segment and at some degree, it will obstruct the birth canal. Hence, patients have to undergo caesarean section. Those patient will be admitted to the ward at the later period of pregnancy. This is because, due to the low lying placenta, they can developed per vaginal bleeding anytime which can lead to torrential bleed. This can cost them a life. Therefore, they are to be managed as inpatient.

There were one group of patients with placenta praevia. Although they were admitted at different time, they became good friends. One by one, they were sent off to caesarean section, according to their times. Those who haven't deliver will go and visit those who already delivered. They always kept each other updated via the whatsapp group. One day, one of the patient with placenta praevia major with underlying one previous scar went off for caesarean section. The surgery was complicated with a few issues but in the end, all went well. She had a caesarean hysterectomy, this will be the patient that I will never forget, S.A.B. My senior and I were there throughout the caesarean section, Bakri Balloon insertion till caesarean hysterectomy. Her friends in the ward were worried because they didn't receive any messages from the her since she who went off in the morning. So they started to ask the doctors what happened to their friend.

I had another 3 more patients, pre-eclampsia patients. They became good friends as well. 3 of them were induced at about 34-37 weeks. They delivered about the same time. Normally when i walked in and out from the antenatal ward, i can see one placenta praevia geng and one pre-eclampsia geng. Their bonding were quite strong. Good thing, at least they became friends and have companion. At least, they were not so boring when they were in the ward.

All of them were very polite.

All delivered before I left the antenatal ward.

I guess, they are friends for a season! Haha...