Oct 27, 2017

The Man Who Asks Too Much

Sometimes it is unrealistic to be true to your profession. The four cardinal ethics of being a doctor that has been repeated over and over in my university days (and still stuck to my mind) are patient's autonomy, beneficence, non-malevolence, and justice. Briefly, it means that patients have their own rights, we must do good, do not harm, and be able to fairly decide which patients are more in need for the limited resources at your hands. But just by being ethical does not make you a doctor. It is only one of the many facets of the existence of being a doctor.

Empathy, understanding, passionate. These words have been thrown around so much around our neck exactly like a floral lei -  Beautiful, mouthful terms with a sickly sweet connotations to them that sometimes, or occasionally, feel heavy and constrictive. Well, yes, medical schools nowadays set up jerk-proof aptitude tests so that they can select people of the right temperament and attitudes to be doctors. It is rightly done so, because nobody in their right mind wants to be treated by doctors who are rude, judging, and looking at you like another pile of workload that needs to be sorted out.

Each one of you reading this who is a doctor must immediately think, "No, I don't think like that. I treat my patients well." Well, so do I. So does everyone else. So does every House and every jerk doctors you have ever had the misfortune to meet. But treating patients well can be done without those three things I mentioned above. After all, we are doctors, not Mother Theresa. Theresa never had pressures from her bosses, never had to be yelled at by patients and their relatives, never had to catch time and being scolded for half of things she is unaware of.

Now, let's have a moment of truth or dare:
Okay you pick Truth. 

Have you ever, while working over something else in ward, feeling exasperated when being interrupted by other patients over their seemingly endless complaints?

You have tonnes of work to do, there's new admissions you haven't clerked, you know you are in deep shit when three of your imaging requests are rejected and you will be chewed by the specialist later, bloods to be taken STAT, nurses bugging you with patients here and there requiring new branula insertion because the patients yanked them out, and many other gazillion things that can and are happening in your normal everyday working as a doctor. 

That annoyance that you get, either when patient suddenly complaining of assam or angin or pening kepala tangkap belakang or kembung or takda berak satu hari or asking why the droplets in their IV drip stop dripping (don't la interrupt my work for that matter please), do you ever feel guilty for just feeling like that? Or that you don't even have time to think that you shouldn't feel that way? Or is it maybe, you are feeling the why-shouldn't-I-get-annoyed-anyway?

As much as I do feel annoyed and irritated with the many annoying and irritating things that are happening at work, I can humble-braggingly say that not once patients under my care had displeasure with me. Well, I counted difficult blood-taking patients out of the equation because if you can't get the blood after poking the poor person's limbs several time, it is confirmed 100% they will not be pleased with ya.

I like to think that I am tolerable in trying to understand why and what the patients did what they do. Volatile and ill-temperamental patients are not always like that so I will ask why they are unhappy. Slow and not cooperative patients always have their own reasoning and a story to tell. The subdued, the quiet, the sleepy - each have their own plight that they want to voice out but can't, waiting for us to unearthed. And one of them that I will try my best to remember him by as long as I lived, is also pretty much the same.

Thanks for the useless 10-minute introduction. It's really not helpful.

I first met him when I was assigned to cover the Acute cubicle in the male medical ward which is the worse of the two (you know which ward). I remember the first time I interacted with him was after the morning round with the specialist. The specialist ordered some urgent blood investigations for him and being in Medical means you have to work fast. Therefore as soon as the round finished I hurriedly came to the patient to get some blood from him only to be told off by the said patient.

Imagine my inner *what-the-hell-man minuscule fury* at being told off. He said, "jangan nak kalut sangat boleh tak?" I was left flabbergasted. What? "Nanti, nanti," while shooing me off with his hand. "Kasi saya ruang. Saya takboleh orang nak paksa-paksa saya ni."

Oh man. Aku nak cepat lagi kau nak buat perangai buat lambat kerja aku. KAU INGAT aku ada banyak masa ke nak layan kau sorang je?

So I backed away a few steps and stood stupidly silently watching him sat in his bed with his legs crossed. He took his sweet time making crossed face and tsch-ing me for interrupting him. I straightaway classified him as Major Difficult Patient (Non-Nephro) at that time. I was dying a little inside, knowing that this patient will be such a pain to deal with.

I took a deep breath. I counted to 10 seconds. I took another deep breath, which looked comical, seeing that I'm a big, fat giant at 6 feet tall, facing a frail middle-aged man in his kain. In my hand I was holding the plastic kidney dish with the syringe and the needle amongst packets of alcohol swab and citrate blue tube. I approached the patient again, explaining what I'm about to do and why I had to do it.

And he agreed. Before I tied in the tourniquet he complained about the previous houseman who took more than one jab to get the blood out and he was not happy with it. So he pointed out, again and again, at the one spot of the vein where he is 100% confirmed I will get it right in one try. So I just nodded my head, keeping my mouth shut and hoping the patient better be right. Luckily I got it right, so he was satisfied at me.

The next few days managing the cubicle I decided to start small talks with him. Well, I do small talk to some of my patients, but for him, I decided to spend a little bit more time. Really, really lame small conversations like "dah makan ke belum", "masuk sini sebab apa", "tidur okay ke tak semalam", etc. After a while he started to talk to me about his visitors, how he had mental health issues that sometimes kept him sleepless at night, and that he wished more people will treat him better instead of ignoring him.

He was later transferred out to Subacute ward a few weeks later. I met him again when my colleague and I was working night shift. My colleague came to me asking for assistance as a few of the patients are difficult in blood-taking, so once I was done with my cubicle I came over to help her. There he was, sitting on a chair under the fan, (again) looking cross and unhappy. I went to him.

"Aku cakap aku nak air. Dari tadi kau orang kata nak bagi aku air. Mana air, mana?" he complained. I was shocked. His speech was not this slow. I hardly understood what he was saying. The reasons why they did not want to give him water to drink is because he was on fluid restriction for his heart failure. But I know this patient. He will give us hell a second opinion if he can, so it's better to let him calm down first. He was particularly crossed with my colleague for not taking him seriously.

Then I explained to my colleague to just speak to him nicely and let him have what he wanted. Some patients are difficult not by default so it's best to understand them because then they will be tolerable and peaceful. I later managed to get the blood from him and let him continue sleeping in his chair under the fan.

A week later my colleague and I were told that the patient passed away in the ward one night after his BP crashed down and did not respond to resuscitation. We were both shocked, my colleague more than me as I already suspected the patient was deteriorating. My colleague said she was grateful that after I reminded her to be nicer to him, she managed to get good rapport with the patient. At least we do not have any unfinished or lingering feelings resulted from our actions or words spoken to him.

You will never know when is the last time you will speak to your patients. Don't let your last spoken words to them to be some excuses we often bullshitting Major Difficult Patients when they request for irrelevant things. At least ask them what is wrong. Ask them why they are unhappy. Explain before you act. Explain what is going on. Ask if they got any questions. Let them be heard. Let them vent. Let them talk.

And for me, yes, let me get annoyed when you interrupt me and making me more stressed out, but I will hear you out. This I promise you. In sha Allah.

1 comment:

  1. I guess this works for any difficult person be it family, friends or colleagues. Sometimes all they want is to be heard & from there one can uncover what's the real issue.