Life as a medical student #9 About Death

Every doctor will experience the loss of a patient at some point of time. Some of the patients will fade peacefully. Others will fight until their last breath. Some plan their funerals, others plan a future they won't have. However, nothing in medical school prepares us for dealing with death. In my third year of medical school, I experienced my first patient death. 

On the last day of my surgery rotation in HKL, I met a lady with both of her legs amputated. Yes it was her. I wrote about her story on my blog few weeks back (You can read about it here). I fulfilled my promise and went back to her on Monday, but she was too tired and weak to have much to say to me. The amount of analgesics used on her was so huge that it made her drowsy. And for the rest of the week, other than sitting by her bed and waited, I couldn't do anything else. When I returned to the hospital after another weekend, she was not doing well. Her condition deteriorated. More and more infection. She could no longer undergo dialysis. The nurses told me her wound was not going to heal. The doctors told me her prognosis was bad. My heart sank. 

On that day, I had a long talk with her mother. Her mother told me how her daughter struggled with her health despite her young age, and she showed me a video of her daughter happily spending time with her family just few months ago. Then everything just happened, so fast and unexpected. She told me how much she didn't want to lose her precious daughter. I was on the verge of tears as I held her hands and said: ''Aunty, remember to stay strong and take good care of yourself.'' 

When I went to find the lady on the next morning, she was no longer there. A nurse told me that she had died last night.

I stood there, realizing that this was supposed to be a meaningful moment, yet I didn't feel anything. I didn't cry. I don't know why but it was not as emotionally difficult as I anticipated. I was pretty calm, maybe because the outcome was expected. Or maybe, I had no right to mourn a patient that I'd only met for weeks. I was merely a passer-by in her life. It was short, but I am glad that our paths crossed.

Does increased exposure to death as a doctor going to ease the pain, does death ever get easier? I don't know. But doctors are human too. We are frail. We should be allowed to feel.

I said my goodbye to her in my head as I left the ward. 

''I hope you had a wonderful life.''

Life as a medical student #7 Empty Promise, No More

When you look back on your life, is there anything you wish you'd done, had done differently or had never done at all? I believe most of us would say yes. Guilt feels terrible. But the worst thing about guilt is that it sneaks up on you. You are filled with regrets and ''if onlys'', and what you did keeps playing and replaying in your mind. Today I have a confession to make. For if I were given another chance, I would act differently.

She was 42 years old, with underlying long-standing Diabetes Mellitus for more than 10 years. One of the most potentially serious complications of high and uncontrolled blood sugar in the body over many years would be neuropathy, which at its most severe can lead to amputation. This lady just had both her legs amputated. Up until the knees. She was lying on her bed when I see her, eyes staring at the ceiling, almost expressionless. She needed help to cut her fingernails, so I offered her help since I was free in the ward.

I had experience cutting fingernails for my mum but it was slightly different in this case. This is because diabetes and wounds are a dangerous combination. There is no such thing as a minor wound - even a small cut can turn into an ulcer, which is what happened to her legs. I have to make sure I don't cut her skin, not even a single bit. I held her hand up gently and slowly, I started to cut her fingernails, one by one. The lady thanked me, and while I was cutting her nails, she told me none of the nurses in the ward willing to cut her fingernails for her. They scolded her because she requested this and that. Her mum just got robbed of her money which was supposed to be her medical fees. She has no medical insurance. Her husband doesn't like her and finds her a nuisance. She couldn't stop crying after the amputation. The pain was unbearable. The only thing she knew was that she lost her legs. No legs. Cannot walk. Cannot run. Cannot go to places. No, nothing. All gone. Shattered dreams. Unfulfilled promises. Her life was totally changed.

I can't feel anything but pain. I am better off dead. 

I paused for a second, holding back my emotion. I wish I could pretend that I was all focus on cutting her fingernails, but no I had to say something. So I told her that with her hands she can still achieve a lot. She has perfect eyesight. She can still see the beauty in this world. She can still eat all the good food. She can still breathe. She is not alone. You are not alone.

She looked at me with gratitude. I guess it has been a while since someone spent time to talk to her and listen to her. She started to cry when she knew that it was my last day in her ward. I promised to still come back to her ward to visit her after my surgical rotation. Meanwhile, the nurses came in to clean her wound, so I left the lady, and I said, ''I will come back later.''

I didn't realise how much this sentence would mean to a patient the moment I said it. I continued with my work and at the end of the day when I was about to leave the hospital, I suddenly remember I made this promise to the lady. I knew I had to go back, but it was a Friday, laziness got the better of me and I thought I could just go back to the ward on Monday. So I left the hospital. But very soon after that I knew I made a wrong decision. I began to feel guilty for not going back. The lady might just be waiting for me to go back! How could I make an empty promise to a patient? The thought of the lady waiting and thinking that another person in this world cheated her and abandoned her again.....I can't believe I could be this cruel.

For the first time ever in my life, I don't look forward to weekends. All I want is to go back to Surgical Ward 11 on Monday. To fulfill my promise.