It's almost a year now I'm in Penang. My education here involves being in the wards 5 days a week except for holidays and sick leaves. I've witnessed a lot of things and been through some tough times. The condition between here and Dublin is striking in terms of the weather, the people and the attitudes they carry. My hospital experience in Penang have opened up a lot questions within me and sparked a whole new internal struggle for me to graduate and do the right thing.
I remember being shown a graph during a lecture with Prof. Hannah McGee, a little old lady wearing nerdy glasses who used to teach me health, behavior and society. That graph was a simple graph on what makes a good doctor. On the x-axis there was competence and on the y-axis there was care. What the graph was trying to say was the two components which makes a good doctor is to care enough about your patient and provide the best health service through competence. Both components would then lead patients to trust you. This is the 1st model of a good doctor that was introduced to me in med. school and it's the only model that I've been holding onto in my quest to pursue medical excellence no matter how far reaching that is to me. The other reason for me to stick with this model is because it's simple. Here's how it looks like:
I've witnessed a lot of situations in Penang where care was neglected. I remember seeing an intubated patient whose saturation was only 60% and pulse was 199/min. He was lifeless except for the fact that he was barely breathing and his heart beating. I came to take a closer look at his endotracheal (ET) tube. It was dilated and filled with greenish thick discharge. That ET tube was his only lifeline for breathing and it was on the verge of clogging up. The only thing I could do was watch and wait. Nobody came to do suction and clean the tube up. The nurses just sat there gossiping to each other while that man was struggling to stay alive. The next day I came his bed was empty. He died.
The above situation is quite a norm in Penang Hospital. In my 1st semester, I kept quite and thought that maybe there was something I didn't know about and so the only thing I did was wait and watch. After I entered my senior cycle I knew that patients like these died from mismanagement and negligence. It wasn't my lack of knowledge, those patients died from pure negligence and care; the only thing I didn't realize back then. Week in and week out, the same situation repeats itself and I found myself at times dreaming and crying at night on my bed knowing that these patients may well have been alive had proper care been delivered. I knew I was powerless as I m only a medical student. I m not supposed to touch anything but........... I don't know. I'm just frustrated to see death, unnecessarily. My friends were also caring at 1st. I remember Chong Ling would hold her file until it touched her nose, Ju Ken would swallow his saliva making his thyroid cartilage move up while maintaining a cool posture. Atikah would just stand straight with her left hand behind her and her right hand holding her file while looking at patients like these. Kamal would come and just say," What's happening?" while Aiman keeps quiet.
Over the year though, I think we've become desensitized. We've found the will to just look away and pretend we didn't see anything. We'd just move on with what we do everyday; clerk cases, present and discuss. Somehow I didn't manage to move ahead. People tell me that life and death is in the hands of God. But what the about the people responsible for it? Do we just let them go? This is a question I found myself asking at the end of this semester. It relates directly to my faith in God and somehow reminds me of why I'm here; so that one day I'm able to save lives. That's all there is to it.
Frustration brings hope. After having patients telling me their GPs prescribed omeprazole for intestinal obstruction and prednisone for moderate asthma without b2-agonists, I decided to change the game a little. Whenever these patients tell me their history, I'd just tell them that their GPs were wrong and they wasted their money. I would then tell them to look for other GPs. Some people say that I'm pessimistic and always think negatively, but that's how I function. When I see something done right, I leave it alone. When I see something wrong, I highlight it and try to correct it. That's how I've always been and always will be.
Care is the utmost importance next to competence. I hope that as I progress and develop clinical competence, my care for patients will also increase. I've taken a few steps to actually try and feel what suffering was like for patients. One of them was having an NG tube passed down my stomach through my throat. Though it was painful, I found this moment to one of the few moments I managed to connect with people, especially my friends. It's one that I'll never forget. Doing so will remind me next time of how painful it was for someone to have a tube passed down through their nostrils into their stomach. I end this writing with a picture that puts a warm smile on me every time I look at it:
- Medicine is a field developed from the deaths and suffering of millions of people from diseases and war. Those who are unable to suffer and connect with death will never be able to comprehend it -
