The story of my night

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We need more hospitals
…actually, we need more hospitals that work for the people.

We need more doctors
…ones who are free to make right choices for the people.

Let me give a real life example.
While working through my shift last night, I had a 40something year old Chinese lady who walked in my room. She looked extremely pale and very lethargic. She slumped on her chair as she spoke to me. Her hair didn’t look real…it was too large for her head. She came in complaining of severe abdominal discomfort and she handed me a letter. She has stage IV gastric cancer with evidence of metastases into her lungs and liver. Diagnosed in a nearby private hospital and she has completed 6 doses of chemotherapy. She had requested to her doctor to change her treatment in a government hospital. Why? Her money’s running out. This is not an unusual situation. I’ve had to manage many many patients who had to turn to government funded hospital because our private doctors have sucked all the patients’ money from their pockets. Anyway, back to the story. This lady’s discomfort is probably coming from the enlarging cancer and the liver. I could easily feel it in her abdomen. Hard. Deadly pieces of mass probably from the mets in her liver. She needed an admission to manage her pain (which is a cornerstone of cancer treatment). She was almost in tears as she begged me to admit her in the wards. I’ve never had a patient grab hold of my hand during consultation before..but she did. She was desperate.

Naturally, this would fall under the oncology department’s responsibility. She has already been given an appointment date at that clinic at the end of this month, but she couldn’t wait until then. The pain’s disturbing her sleep. It was half past 4 in the wee hours of the morning. I called the oncology doctor on call. He couldn’t admit her into the onco wards. Why? Because they have not open her own personal oncology patient file yet. I was stunned. Just because she lacked a piece of paper, they would not admit a patient who already has been diagnosed with nothing else but cancer!

I had no choice but to call another primary team to admit her into their care first then proceed to refer her case to the oncology department from their own ward. Stupid long twisted road to get to the same destination… but that was the only do-able thing left to do. Her kind of cancer fell under the surgical team’s. I called the doctor on call. I hear the reluctance in her voice. But she agreed to come down to the ED to see the patient anyway. As expected, she too, wouldn’t admit the lady into her surgical ward. Apparently they don’t admit patients in their ward just for pain management. Obviously I knew that! They only take in patients who can be treated with some surgical procedure. Patients like her who need pain management are usually admitted into the oncology ward… who is not accepting her because she has no file.

I’m not bad talking about this doctor. I understand her situation as well. She is restricted to set of rules made by her boss that there is only a certain set of criteria that must be met before admitting patients into her wards. I’ve seen them workout patients very thoroughly first before even considering to admit. Having surgeons breathing fire down your neck isn’t the best thing to experience. But here in our hands, we have a lady (with a known cancer, mind you) in pain who is stuck between nowhere because of the red tape drawn to protect everybody’s own bum. What did she do? Discharge the patient back home with pain meds. Now here’s a pointer for those of you who thinking you might come to the ED for some illness someday. We can’t discharge patients with any pain meds stronger than sodium diclofenac (an NSAIDs). Those meds probably fall under the moderate pain control group. It’s like trickling a small stream of water in a blazing fire to put it out. It’s not as bad as sprinkling water, but it won’t help… as much.

In the same time, I do understand why some of these red tapes were drawn as well. Our wards are crowded. It’s ridiculous how people just love to flock to HKL. In fact, earlier on last night, we had a staff announcing that the female medical wards are already full and that we had to be judicious with our admissions. Not that we’re not, but the sieve has been made thicker. I heard that patients were already only on chairs.. they’ve ran out of canvas beds.

Why is it this way, you ask?
ONE: There is this generalized mindset among society that treatment in HKL is reliable and that it works. Because they’ve been so used to coming to HKL, it was the only place they could think of going to. Because the medicine in HKL works. Because they were born in this hospital. Because it’s cheaper than UMMC or HUKM.
TWO: Because the newer high-tech hospitals have been programmed into a system whereby they will not take in anymore patients than they can keep. The computer system will not allow them to do so. So any excess patients that appear at their doorstep when they have reached their maximum patients in ward, will be sent to none other than HKL where we still work with pen, paper and computers which are still only in black and white.

That’s why our wards are full. That’s why many lines are drawn about admitting patients. That’s why some patients like this lady have no where else to go but to suffer back home with her little pain meds and wait for the end of the month so she can see the oncology clinic proper and have her file opened.

I had to return back to her bed where she was resting to talk out what was decided by the doctors on call. She was feeling better because we had injected her with some high powered analgesia. I could sense the disappointment in her. I wished there was something more that  could do. I wrote another referral letter to Oncology requesting for them to consider bringing her appointment date forward. Since she was in the area, I asked her to bring it to the Onco Building once office hours began. Told her to cross her fingers that the letter might do some magic… and I bade her goodbye.

I wished there was something we could do to make all of this better. I wished we wouldn’t have crowded, unhealthy wards. I wished things were not so difficult for simple matters.

We need hospitals unparalyzed by a rigid technology system. We need hospitals, not even the partially private ones.

And that must begin with doctors who care and see what’s it like at ground zero and most of all, are empowered to do something about it.

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3 thoughts on “The story of my night

  1. Well… I think these kind of people are all around. Study or working, what I can do is try not to be affected by their “virus” and do all the best I can. It’s hard to accept the truth sometimes… haiz~

  2. Yunn Wen says:

    It is a shame when you have to practice under such circumstances, where poor rigid system not able to provide the best medical service to these patients. Anyway I am quite surprise to hear that docs aren’t allowed to prescribe analgesia beyond NSAIDs. Hmm…now that is really frustrating. Anyway I am hoping that you are feeling better by now ><

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