I stand in front of the white gigantic building for a moment. It looks old but preserved, and smells of formalin and other chemical agents. This place is very familiar to me. I was born here, somewhere in that building; which I can’t really remember. Two of my uncles were admitted here; at the emergency department, both due to motorcycle accident, each in different year. And they both had their last breath there. My grandmother used to have her dialysis sessions here also, a few times a week. She also, had her last moment in the white building. Indeed, Hospital X reminds me of so many people and memories. Different times, different reasons, different outcomes. But today, I come here for a special reason: to start my elective posting.

I walk quickly inside, heading straight to the information counter. Many people have already been in the building since early in the morning. Some in uniforms, while some are not. After asking the lady where should I go for registration, I go up to the second floor. I don’t bother to take the elevator because it is always packed with visitors, health workers and patients. But mostly visitors, of course. I climb the stairs, keeping myself motivated so as to start a whole new experience of a lifetime. I keep telling myself to stay positive and be a quick learner, knowing that I hadn’t been exposed much to the style of working at hospitals in Malaysia. As I introduce myself, the registrar gives me a form to be filled and tells me that I’ll get my name tag first thing when I come tomorrow. She tells me to start at the Paediatric outpatient clinic, which is located on the same floor.

As I reach the Paediatric outpatient clinic, I see an Indian girl, who looks like a student as me, walking back and forth outside the clinic. She seems to enter, but hesitates.

“Hi, I’m Sarah. Are you here for elective posting?” I’m trying to be brave and friendly.

“Yes. You too? I’m Zarul. Nice to meet you,” she smiles back. ‘Zarul’ is an Indian name? For girl? I stop myself from asking her that question. Maybe I’ll figure it out later.

When I grow up, I want to be a Doctor!

After briefly introducing ourselves, we walk inside. There’s a group of people wearing white coat, talking and discussing something. And there are some older ones, not wearing any white coat but have stethoscope with them too. The latter must be medical officers and specialists. While the earlier are house officers (housemen). I follow Zarul, sitting beside her. Zarul is a fourth year USM student and she already seems like a houseman to me.

“What are they discussing?” I whisper to her. We sit two rows behind the other doctors.

“They must have started with cases discussion. It’s 8.15 a.m now. Usually they start exactly at 8 a.m or maybe earlier.” Zarul says while looking at her watch.

A few seconds later, a Chinese houseman walks to the front to present a case. She has a piece of paper in one hand. It must be the case report. Everyone else starts to pay attention as she speaks. She starts by the patient’s personal history, then about the diseases, some problems and stuffs.

And then a Malay MO stands up and says “But the problem with this patient is, her father never allows her daughter to have blood transfusion. Once, he took her away from the Hospital Y, in the middle of blood transfusion. Today, she’s admitted here, in this hospital. How do we plan to manage this patient without having any interference from the father?”

“We should call the police, if he takes his daughter away. What he did is life threatening. What if he does the same thing here and her daughter collapse afterwards? He might blame this hospital!” someone says. Some doctors giggle at the idea of calling the police.

I have to ask Zarul to explain the situation to me. She seems to understand almost everything, while I’m not.

“You see, the patient she talks about is a thalassemic patient. She has thalassemia. And of course she needs blood transfusion every month. But her father doesn’t allow that to happen because of some myths he believed. I mean, he doesn’t want any stranger’s blood in his daughter’s body. The girl’s condition is worsening from day to day! Can you imagine what might happen to her body if she doesn’t get her blood transfusion? Sooner or later, she might die!”

Wow. Doesn’t anyone explain the bad consequences to the father? Of course many doctors already did. But to change someone’s belief is a real challenge to anyone. When the mind had been planted with some kind of beliefs for years, it’s hard to remove them. Well, maybe we can try ‘inception’. But that’s out of the options for now.

The cases discussion session continues for a few more minutes. After that, Zarul pulls my hand and we stand up to meet our supervisor, Dr Yeoh. She is a slim Chinese woman, most probably in her mid forties. She is a subspecialist in Paediatric neurology.

“Well, it’s good to have you two young ladies today. You’ll be under my supervision for the next three weeks. And we’ll do lots of fun things together!”. She seems so enthusiastic. I’m glad she’s not the kind of malignant doctor that I’ve heard of.

“Now let’s g to the ward for the morning round,”

The paediatric ward is divided into five sections. Each section is occupied by patients admitted under the same type of disease. For example, the first and second sections are for patients of urinary tract diseases and fever of unknown origin. The third one is for neurological patients and the last two are occupied by respiratory and cardiac patients. There are also two isolation rooms at the back.

We start the ward round from the front. From one patient to another. Every patient’s details are presented by a houseman. The housemen’s job is to tell the MOs and specialists the patient’s history, analysis of complaints, investigations done and treatment plans. There are times when the specialists ask some questions and demand for explanation on what kind of management the housemen had done. I feels butterfly in my stomach every time a housemen is asked. I don’t think I can answer any of the questions. But on the other hand, Zarul seems to be participating in the discussion. Just wow. You go, girl!

When we reach the neurological section, Dr Yeoh starts to explain this and that. The first patient is Syafika, a twelve years old Malay girl with Down syndrome. She looks cheerful, babbling something to her father who is sitting next to her on the bed. Her mother is talking to Dr Yeoh, explaining something about her daughter’s complaints. She mentions that it all started a few days ago, when Syafika complained of back pain and it keeps worsening from day to day, that there were times when she cried hard, pointing at her back. That’s why the parents brought Syafika to the hospital. The houseman in charge has already taken blood samples and CT scan has been done. We are now waiting for the results.

Tendon Reflex

 

Dr Yeoh asks Zarul to get a hammer for her. She wants to check Syafika’s tendon reflexes.

Before we move to the next patient, Dr Yeoh uncovers Syafika’s shirt and we see that her abdomen is distended.

“Does she complain of stomach pain?” Dr Yeoh asks the mother.

“Err…sometimes. But we think she’s just saying it because she wants some attention.”

Dr Yeoh doesn’t say anything. Her face looks serious. She puts one hand on Syafika’s abdomen and starts palpating. The houseman in charge, her parents, Zarul and I, are all waiting nervously for her to say something. Dr Yeoh stops palpating and turns to the houseman.

“Did you check her abdomen?”. Her voice is stern.

The houseman, who is a young Chinese woman, hesitates. “Yes, I did. Doctor, can I talk to you for a minute?”.

And they move to a corner to discuss something.

Zarul and I move to the next patient. A Chinese boy; diagnosed with autism but admitted to the ward due to fever and delayed growth development. Without being told, Zarul approaches the boy’s mother and starts asking questions. At first, Zarul speaks Malay. But the mother doesn’t really understand her. Surprisingly, Zarul starts speaking Mandarin. Fluently! Hats off for you, my friend. I really admire her confidence. Being able to speak many languages is indeed a bonus.

We are busy going from one patient to another that we don’t realize Dr Yeoh has returned to Syafika’s bed. Are the test results here? She’s having some white papers with her and it seems that she is giving her full attention to the details inside. Out of a sudden, I feel a little uneasy when Dr Yeoh gives the houseman a nod. What does that mean? Is Syafika going to be fine? Is she in serious trouble?

-illustrating picture-

At the same time, the radiological results; CT scan, arrive. Dr Yeoh quickly scans through the films, looking for something specific. A tumour? An internal bleeding? What kind of abnormality could Dr Yeoh possibly be looking for? She asks the houseman to analyze the results with her. Both of them have this kind of ‘this-is-seriously-not-a-good-news’ look on their faces. Zarul and I are watching from far, so as not to interrupt anyone.

After a few minutes discussing with the houseman, Dr Yeoh approaches Syafika and her family. She starts to explain everything in the most simplified way, to make sure the parents understand every detail.

“Sir, madam, the test results are here. Both from the lab and from the CT scan Syafika had earlier. The reason behind her stomach pain and back pain is…I’m sorry to tell you, it’s tumour,”.

Both the parents’ expressions change. Syafika’s father kisses her and carries her outside the ward, maybe for a walk. Or maybe to avoid Syafika listening further. Or perhaps to give room for both his wife and himself to calm down. To think of something. To pray.

The mother cries. It’s so painful to witness something like that. I turn my face away, pretending to look at other patients.

“We…we have been raising her for years. Did…did the best thing…to take care of her. Now she…she’s going to die?”.

Dr Yeoh puts her hand on the mother’s shoulder.

“Madam, Syafika is a very lucky child, to be raised by such wonderful parents. Her developments are good, for a child with Down syndrome. Both you and your husband did very great things for her. But her defense system is not like us. She’s vulnerable to infections and diseases. And now, the tumour is spreading to her entire body. Her bones and abdomen are affected,”.

Oh God. I gulp.

“What can we do, doctor? Please. I…I can’t afford to lose her. She’s our only child,” the mother sobs.

“Madam, whatever it takes, we must try some treatments. We must do it quickly before the tumour affects her brain, respiratory system and heart. But unfortunately, I have to refer her to a bigger hospital because we are not completely equipped for such cases here. I will write a referral letter to my friend, at another hospital,”.

“Will it save her, doctor?” the mother asks, full of hope.

“Madam, I cannot guarantee she’ll be completely healthy as before. But I believe we must make some efforts. At least to ease her pain. To let her live properly for the remaining time she has. Have faith, madam. We must try our best till the end,” Dr Yeoh says calmly.

I’m impressed with her way of explaining things to the mother. They are not of the same race, or even religion. But she knows the right thing to say at the right time. It must be very hard to tell someone that their loved one is dying. Dr Yeoh, and any other senior doctors must have encountered the heart-breaking situation for countless times.

To be continued . . .

Siti Sarah binti Mustaza
6th Year
Faculty of Medicine
Ain Shams University

Karya Unit
Publications and Information Bureau
PERUBATAN Ain Shams Chapter

The author has also written several articles for PERUBATAN Online website such as O&G: Oblivious and Grandiose . Click these links to continue reading her articles .

STATEMENT
This article is the personal opinion of the author and do not necessarily represent the opinion of PERUBATAN Online.