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The Death of Patients

Last two weeks, I encountered a patient with a very bad history of fever and flu symptoms. I tried everything that I could at that time, working as a district hospital medical officer, and still she didn’t survive. I called for help, asked for my seniors for their expertise and even called the on-call specialist that was at the tertiary hospital.

The last words that I remembered from the specialist before I dashed to help the patient was to just save her with whatever I have and with all the effort felt like it was poured down the drain after about two hours trying to revive her. She passed away in front of both parents, and I was the one who witnessed the death and wrote her death certificate.

What made it worse?

She was a three months old baby.

A mortality for children under five years old is seriously frowned upon and definitely a bad headache for any attending medical officer. That is also why the main reason I didn’t want to spend my time in paediatrics ward; they are special. They are fragile, they are too young. I can’t stay around them and not having teary eyes (not bleary eyes due to lack of sleep). It’s a love-hate relationship. I hated children crying for as long as I remember, and yet I loved it when I first birthed my son, when he came out of my womb, looked like he was choking and I needed to rub harder on his back before he started coughing and cried.

The baby that I couldn’t save was a child of  Rohingya refugees, and back then when I remembered it was so hard to dig out information from them because of the language barrier. Neither of us know what the other was saying. The father speaks only little Malay – I think it was less than ten – and the mother knows none. I didn’t know sign language and neither were them. History was out of place when the baby came and I needed to revive her right away. In the healthcare system, non citizen will need to pay for whatever reason they come unless it’s an emergency. The baby was an emergency case and I stamped URGENT and NON CITIZEN on their lab forms, indicating how I needed to save her despite the little information that we had.

It was a night full of adrenaline rush – I think more than what we gave to the baby, the adrenaline that was running in my veins – and I couldn’t let go of it almost about a week later. I thought about it time and again, and discussed with my colleague about what we could have done. I was affected even though this was not my first death, maybe because sh was only a child. She knew nothing about the world, she was at the mercy of her parents.

In the end, I blamed myself. But what more can I do? I spent almost three hours trying my utmost best to revive the baby but to no avail. I asked the parents to pray with us, to stay with the baby as she was fighting to stay alive, I could still see the baby’s too strong to give up too early but she finally gave up. She must be in heaven right now, staying with the angels again.

I revised the red book – provided by every government hospital upon discharge after a baby’s birth, and found out that she missed her injections. It’s a very common scenario among the refugees as every treatment – the medications and the vaccinations given are not FOC as what we did with the citizens. They need to pay a certain amount and with the UNHCR card that they have, they are only eligible for only half of the price for non-citizens to pay. Means, they still have to pay for quite a high price compared to what the citizens paid – a freaking RM 1. Even mere nasi lemak at the side of the road now is more expensive than that it’s ridiculous.

What if she was not a refugee daughter? What if she’s somewhat a citizen?

Maybe she would lead a different life, but it was only if.

We can’t change the future, but I can definitely be more alert and learn more.

The death of a patient sometimes are too bitter for us doctors to swallow.

I witnessed a lot of death, I signed a handful of death certificates too, I fought and lost that I lost count. But the aftermath was not like this baby.

My first death was when I had just started working, in fact I was day two in ward. I was fidgeting, I didn’t know the medical terms, I’m not used to system, I’m knew to the ward, everything was alien to me. I wasn’t alone though, there were also my seniors. But they were also housemen, just like me but unlike me they already passed a couple of postings before they were in medical ward.

It was my day two of working and the morning was peaceful. Most of the patients were stable, but suddenly a patient from the back of the ward collapsed.

What is collapse?

In medical terms, or if you’re working in the same environment as me, COLLAPSE is the most frightening term you can hear.

Someone’s patient is deteriorating, as in maybe the blood pressure crashed, or the patient unresponsive or the cardiac monitor showed asystole reading. ASYSTOLE – the flat line you used to see on TV.

All of the doctors are required to leave their work and work their ass off this patient. I remembered I didn’t have to perform CPR – the chest compression thingy that all the TV men love – because I was the only lady doctor there. The others were men, the whole lot three of them. They took turns to do chest compression and my task was to inform the vital signs – blood pressure, pulse rate etc – and bagged the patient. It was tiring, we were sweating, and I remembered my knees were shaking.

It was terrifying as I witnessed how the patient fought to live. Her eyes were closed, and the chest compression were so vigorous and rough that I think they cracked some ribs doing it. The blood pressure didn’t pick up, and the pulse not palpable. The shaking knees weren’t help at all. I want to bite my nails, but my hands were preoccupied with bagging the patient.

They pronounced death for the lady after forty five minutes of resuscitation.

Then, I just went back to work, just like nothing happened.

I just witnessed my first death.

And I walked away from the deathbed.

She was just another patient. We have a whole ward of patient, relying on us to not let them down.

But she was a mother. A sister, maybe. A daughter to someone. Someone’s relative. I even heard the wail of her daughter when my medical officer announced to her, delivering the bad news in calmest way possible. The wail was so loud that other patients and their relatives stopped and looked away. It’s not possible for the others to stare, it was too painful of a sight to look at.

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