In the Medical Ward...

It has been a while since I wrote in proper English after my SPM exam until today. Seasoned by the experience of slightly more than half a year of clinical experience, I was asked to write an essay regarding internal medicine posting. The first thing that popped in my mind was just a repetition of three words- hectic, hectic and hectic. I wonder if there was anything rather more interesting than examining young female patients legally, with a yellow license clipped on my formal attire. Although it sounds interesting, I’m sure all medical students who were in my shoes will find it perplexing as most of the time, we are not sure what is exactly that we are examining.

Other than those “interesting” events in our clinical life, I can hardly scavenge fading memories regarding something particularly interesting that happened somewhere around October 2011. That was a fine day among hectic days, when all the year three medical students were so occupied with the preliminary tasks in their mind, mainly filling up their log books. My plan was to get at least 5 signatures of all the blood taking procedures from the hopefully kind MOs or HOs. And there is no free lunch here. I was prepared to be summoned here and there to help with this and that. The actual situation that happened that day surpassed my wildest dream. I haven’t enough cortisol or adrenaline to face the situation which has doomed to happen in this normal day. I was a medical student and today I deal with a real life!

It was 5 in the evening. This is always the time of day when we (some hard working student might disagree with me) doze off pretty easily. It was in Ward 7B, a ward with a number of acutely ill patients struggling to stay alive. During the day, most of my course mates were discussing what food to eat next and I wanted so much to join them. As always, I was not really feeling considerable to spare the patients with funny sounds in their lungs or hearts my time but I knew I had to do it anyway. My cold diaphragm of stethoscope was gently applied on their feverish chest. Of course, I asked for consent before I do so even though I realized that deep down in their heart they wish to left alone to breathe peacefully.  But what to do, I really wish to be a good doctor…

Initially I thought the few bizarre presentations from the patients would have made my day fantastic enough. When I was just about to happily leave the ward, I sensed something amiss at the corner. A few MOs and HOs were rushing towards a bed hastily with gloves and masks. It was not the first time to see situation in a medical ward. However, driven by curiosity, I approached the bed, trying to figure out what has actually gone wrong through the anxious expressions on those young doctors’ faces. From far away, the ringing of alarm from the machine seated at the bottom of the bed was clearly audible. Each wave of frantic alarm pervaded the atmosphere, stimulating adrenaline rush from everyone out there.

Slowly, some of the familiar faces started to appear in front of me. Then came Shafiq and Liyana (and also a few dudes I have forgotten who), who were still lingering around the hospital ward with unknown reasons (they are not ghost, they are good medical students…, just like me.). “Eh Pang, ape bende ni…” “Mane aku tau… Itu houseman macam tension gler…” “Nasib baik kita medical student je… Kita tengok je la…” We merely chuckled as we knew that was the only thing we managed to do at the moment.

Half an hour was gone, and we were still standing beside the bed. We realized that this patient was a TB patient. At first, we still could see the jerking of the leg of this patient whenever an intubation tube was inserted forcefully into his throat. “Ni mesti sakit gila…” Shafiq uttered this with chills and rigors. Then, a houseman started to surface mark the midinguinal point for femoral pulse. I assumed he wanted to dig some blood for ABG. He failed a few times to locate the arterial blood. Every time the large bore needle was pierced into the false area (I guess sometimes accidentally pierce the inguinal ligament, femoral vein or bla bla…), a clear brisk contraction of his quadriceps muscles was visible. After a few attempts, the houseman was happy. I could remember vividly Shafiq’s facial expression, as if he was the one lying on the bed.

Another half an hour was gone. This time, the MO in charge took a resuscitation bag and instructed the houseman to pump in air into the patient’s intubated throat. The resuscitation bag was blue in colour and looked soft to be pressed on. Therefore Shafiq was curious to ask me the following question, “Kenapa mereka mcam letih je tekan itu bag…” I could not answer him as I was having similar question mark in my heart. Therefore my answer to him was, “Pura-pura je mereka ni… Mau tukar shift awal kot…” My irresponsible answer was immediately replied with a bad karma, when the MO shouted at us. “Medical students right? Why are you guys standing there? Take a mask to come and help!!” That moment I knew my statement regarding the resuscitation bag is going to be justified as a FALSE statement.

All of us (the innocent medical students) bravely took a mask and a pair of rubber gloves, put them on, and tried to aid the resuscitation. At this point of time, we were all consuming glycogen store in the liver as all the glucose available in blood stream was all used up in the afternoon to examine patients. Perhaps God was trying to let me understand how hard resuscitation was. The first thing I was asked to do after fixing the patient’s leg immobile is to pump the air to supply oxygen to the patient. Oh god… I’ll bet you’ve never pressed such a hard rock stony dull bag in your life before. The perspiration drenched my formal shirt, my tie, my long pants, and my underwear, my everything… Now I realized the houseman was not hoping to end their shift earlier…  Shafiq was very clever. He stood beside the patient at the end of the bed, never wanted to approach the patient’s head… His duty was pretty easy, to hold the patient’s leg. I looked at him with an eye expressing vengeance. However, he dodged my eye. I can see his smiling mouth under the mask.

The patient SaO2 gradually fell. Then we have reached a moment to perform CPR on his chest. Again, I started the task as instructed. Now Shafiq has to take over my job. Once a while I look at him and I was happy to see him suffering now. Out of the blue, the patient vomited his blood. The blood spilled all over and onto his, her, their, your and not to forget, my face (here I exaggerate a bit to make it fantastic). The houseman was grateful that she was wearing an apron. I was pissed off that I was not wearing an apron. Shafiq was pissed off that he was not wearing an apron. Everyone there basically, was pissed off that they were not wearing an apron…

Now it was 7 pm. Oh god, I really could not stand this anymore and hence my question to Shafiq and subsequently to the houseman (after getting no answer from Shafiq), “We need to do this till bila ah Doctor?” The houseman, unsure with his answer, replied me “Until the ventilation machine arrives.” Then my next question will be “Bila itu machine boleh sampai?”… But before I throw my question, the houseman ran away to get some stuffs from the counter, probably he also did not know BILA.

Now it was 7.45 pm. An angel arrived (as if from the sky) in front of us and started plugging all the colourful wires to awaken the machine. Shafiq, with a BIG SMILE on his face, announced to me that we have rescued the patient successfully! WOOHOO… (I will skip this part for some reasons you will understand in the next paragraph.)

All of us announced this good news in Facebook and many of our friends congratulated us for the noble deed. We were all intoxicated with the perception that we have finally saved a life. However the joy lasted for only less than 12 hours. The next morning when we visited the hospital, with the hope to see the patient improving from his deadly situation (and not to forget to show off to our friends), we were informed that the patient passed away in the middle of the night. The bed was now replaced with a new patient with Asthma. As expected, we wrote that in Facebook and ended our sorry drama.

I did not know exactly if we have actually rescued his life, or made him suffer before he died. Perhaps during the hectic pace we tend to forget the pure heart we possessed once upon a time. One thing I am sure is that we tried our best to ensure he stays alive. I know I am going to face this repeatedly in the future. Oh yes, when I went back to my hostel that night, I disinfected all the clothes with highest possible dose of disinfectants (my mom even ask me to throw away my attire). Then a few hours later only I started to develop fear if that cute little M.tuberculosis would have survived and berjinak-jinak within my innocent macrophage? Will I develop a full-blown TB when I am immunocompromised at the age of 70 (hopefully I can live until then) with all sorts of chronic diseases like DM… And end up as a subject to UPM medical students in the same ward in the year 2058? Do I need to take prophylactic anti-TB agents? …

What do you think about the above experience?

Before I end my "essay", I got all the blood taking procedures signed and a few more as a reward of resuscitating the patient… Moral of the story: Do good things and God will always reward you with something nice.

Pang Sui Jin, 3rdyr 2010/2011


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Editor's note: Pre-clinical students are encouraged to go clerk patients in the surgical (Ward 6A-6B HSDG) and medical wards (Ward 7A-7D HSDG). The turnover rate is pretty high, and learning clinical skills and how to develop rapport with patient early on is priceless. Ask your seniors to teach you weekends ke, senior batch 13 semua baik belaka, jadi usah takut bertanya. Sorry terpromote batch sendiri.