Friday, July 7, 2017

Glimpses of Love and Love Lost

I've encountered many elderly widows who were living at home alone throughout my short medical career. In the past two months in ED alone, I have had multiple memorable encounters that left me pondering life, thanking God for all that I have in the present as well as feeling very blessed to have had a kind stranger open up to me about something so close to their hearts.

...

"It's my wife's engagement ring," he said as he pointed to the ring he wore around his neck. 

"She asked me to take care of it when she couldn't anymore. We were married for over 50 years. She was a really good wife.. And now that I can't drive anymore, how will I go and see her? I like to go visit her, just to have a chat and all."

He broke out into heavy sobs.

"I loved her so much."

...

"I moved here from New York all those years ago when I was working as a model. Sold all my designer clothes and bought a plane ticket. And if I never did, I would never have met the handsome Australian man that was the love of my life.

Every morning I wake up and look at his photo and have a chat with him. "It's all your fault!," I'd say. "What did I do?" "Well you up and died and left me all alone, that's what you did!"

But, he was a good man, he really was. And I do miss him so."

...

With both her broken arms up in slings, she said to me, "I'd been married 57 years dear. Let me give you some advice dear. Never go to bed angry. What's it that they say? Never let the sun go down on your anger. Sure couples will disagree, but you need to always hug and make up. Promise me, you'll hug and make up. That is the secret to a happy marriage. 

When you meet the right person, you'll know."

I smiled at her and replied then, "I know." :)

...

She held on to my right hand tightly as tears streamed down her face.

"After he died, I started getting a lot of blood in my poo. The doctors put three clips in there and said it was a stress ulcer in my stomach, from all that grief.

He was a wonderful husband, and I've had 60 years of wonderful. I know that's more than many people get in their lifetime. Many couples nowadays break up, or stop loving each other, but I got to have him. 

Sometimes I wake up in the morning and I still feel him waking up next to me."

Saturday, June 24, 2017

Debrief: One Night in Emergency

My consultant spoke to me gently, "You know, in the grand scheme of things Candice, uraemia isn't such a bad way to die after all."

...

She had metastatic bowel cancer, and had come in for yet another episode of small bowel obstruction from the extent of her metastatic disease. This was further complicated by her worsening kidney function because both her kidneys were grossly swollen for the same reason.

I was surprised as I scanned through her previous medical notes to see that I had met her before last year when she was an inpatient - despite reading the medical summary I had written, I still could not put a face to the name. I had written then that her oncologist had advised her chemotherapy was failing and that further chemotherapy was unlikely to be beneficial.

But, she's a fighter, this woman. 

She insisted then that she wanted to press on with curative chemotherapy, and when I went to see her that night, insisted again that she wanted the kidney surgery it that's what it took to keep her going.

And when I brought up the issue of resuscitation with her, she repeatedly told me calmly - "I will leave it to the Lord. Let His will be done."

When I picked her up from the list of patients awaiting to be seen that night, I knew she was sick. She most certainly had a small bowel obstruction, and her bloods soon revealed that with her declining kidney function was a potassium level of 6.6mmol/L. This was a severe elevation that required immediate treatment, and further increases could well result in cardiac abnormalities and eventually a full blown cardiac arrest.

Her nurse and I got to work immediately. She needed an urgent ECG, intravenous insulin and dextrose to drop her potassium levels, oral contrast, an abdominal CT scan, intravenous albumin, intravenous pain relief, repeat urgent blood tests, a nasogastric tube, a chest XRay, discussion with her usual private specialists, cardiac monitoring, and a signed not-for-resuscitation form.

We managed to bring her potassium down to 5.5 mmol/L, but her blood sugar level came down with that as well to 3.3mmol/L. That needed to be treated with more dextrose, and then her potassium was noted to start climbing again - now 6.1mmol/L.

What we were doing then was simply putting band aid after band aid on an actively bleeding wound. She needed kidney surgery to improve her kidney function, and all the insulin and dextrose in the world was but a temporising measure to attempt to stabilise her. And at this stage, she was by no means a candidate for dialysis.

Her CT scan later revealed a large pelvic metastatic mass that was compressing on her bowels and her kidneys, causing her presentation today. I spoke to her usual private surgeon who accepted her for transfer across to a private hospital where she usually gets care from.

Still, I worried about sending her across to a private hospital late at night with such unstable potassium and sugar levels. So, at the advice of a colleague, I made the decision to call the covering ICU doctor in the private hospital who was aware of this patient being transferred across. I had the intention of updating her of present issues, but was informed instead that her usual team of doctors were planning to discuss withdrawal of treatment and end of life care with her come morning.

...

How do you tell a woman who has been fiercely fighting for so long, that this was going to be her last fight? 

...

Stepping back and looking at the whole picture, I knew as well that that was the best thing for her. Her disease had reached a stage where it was overwhelming and no amount of surgery or medicine could fix it. Palliative care was definitely a most rational decision, but after hours of fighting with her, the news came as a surprise.

A dire sense of inevitable helplessness washed over me as I considered her young age and how her time was about to run out. I felt deeply saddened for the fate of this woman and extremely defeated as a clinician.

I know that I am still so, so early in my career and will see many more cases like this in the future.
I know that I've known and treated her for a matter of just hours, whereas other doctors have been tirelesssly fighting with her for years and have gone to even greater measures to help her get just a bit more time.

And yet.. once more, the world simply continued to spin madly on. 

Sunday, June 18, 2017

As Simple As Kindness

She was a "frequent flyer" in our ED, known to often present intoxicated after an alcohol binge.

The term "frequent flyer" is often responded to with a flurry of groans from ED doctors, what more when infamously coupled with "substance abuse". In the midst of busy days and sick patients, these patients are often labelled and stigmatised from the very moment they are triaged.  

I'd like to write that I was a doctor who was above that sort of petty judgment, and that I was one who always saw the best in people right away.. but if I were to be honest, I too often struggle to see beyond those triage descriptions. 

But that evening, as she lay on a bed drowsy from what she had been drinking and smelling so strongly of alcohol, I watched my boss respond to the situation differently. 

I watched my boss respond with kindness.

I stood by the door quietly and watched as my boss got down to her knees to be face to face with this woman. 

She spoke to her gently, reassuring her that she would be safe in hospital that night and that we would let her concerned partner know she was here. 

See, there's politeness, and then there's genuine kindness.

As I watched this scene before me in the midst of all the activity going on in this emergency department, I could tell that this was a genuine encounter, and that my boss looked at her and saw a person instead of just a label. 

Completely humbled, I stood amazed. Here I was, just starting out in my career yet already disenchanted by patients who come in with substance abuse, and here she was, years and years of experience yet still carrying a soft heart for these people who were broken and hurting. 

This woman will almost certainly never remember that encounter, and more than likely represent again one day for the same thing. 

But I know.. that kindness is never wasted. 

I believe in my heart that kindness is extremely powerful, and that God uses it to inflict change and influence the atmosphere. I believe that it reflects the love that God has for His people, and that we are being "just like our Father" when we demonstrate genuine kindness.

There's just something about kindness.. it's vulnerable, selfless, incredibly brave, surprising, and even rebellious as it rejects responding to an unfavourable circumstance with an earthly, natural, every-man-for-himself-in-a-dog-eat-dog-world perspective. 

So teach me Papa I pray, show me how You do it. Teach my heart to love others as You do and to see beyond a label on a screen and the sum of their choices in life. Change my perspective of others and grant me the courage to be bold and rebellious as I do things your way, and not mine. Remind me of the soul before me that I am privileged to encounter, and am empowered to bless. 

...

"Then the righteous will answer Him, saying, " Lord when did we see You hungry and feed You, or thirsty and give You a drink? When did we see You a stranger and take You in, or naked and clothe You? Or when did we see You sick, or in prison, and come to You? And the King will answer and say to them, "Assuredly I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me.""
- Matthew 25:37-40

"Do not forget to entertain strangers, for by doing so, some have unwittingly entertained angels."
- Hebrews 13:2

Monday, May 8, 2017

Soul Food

"Meanwhile, the moment we get tired in the waiting, God’s Spirit is right alongside helping us along. If we don’t know how or what to pray, it doesn’t matter. He does our praying in and for us, making prayer out of our wordless sighs, our aching groans. He knows us far better than we know ourselves, knows our pregnant condition, and keeps us present before God. That’s why we can be so sure that every detail in our lives of love for God is worked into something good."
- Romans 8:26-28 (MSG)

"Be still and know that I am God"
- Psalm 46:10

Friday, April 7, 2017

The World Spins Madly On

...

Someone passed away tonight.

I sat on my chair facing cubicle 6 where the curtain was slightly opened, and I could see her lying there, pale and lifeless. The lights were dimmed, and her husband was crouched by the side of the bed, sobbing.

She was even younger than my parents.

I thought of her kind, weary smile today when I told her that she did really well with us having to transport her across the hospital. I patted her arm, and I held on to the tubes which were helping her breathe.

I thought of the tears in her eyes today as she grew more and more exhausted.

I thought of how my eyes weren't the only red ones amongst our staff tonight.

And in that moment, I thought of how nothing else had changed outside that cubicle.
Nurses were running around caring for their other patients, computers kept beeping, the lights were bright and other people were still chatting away happily.

The world continued to spin madly on.

But one thing's for sure, for everyone who loved her and was left behind to live without her, nothing would ever be the same again.

Wednesday, March 29, 2017

Child Of God

Isn't it amazing.. that despite it all, He calls us redeemed? 

Beloved, child, fearfully and wonderfully made, Mine. 

"BEHOLD, what manner of love is this, that we should be called children of God."
- 1 John 3:1

Monday, March 20, 2017

All I Really Needed

Today wasn't a good day. 

I woke up feeling unwell and had errands to run. I had some stuff on my mind. I'm more emotional than usual. The embassy wouldn't let me collect my police check even though the half hour I spent on the phone with them a few days prior said to just show up. They told me the money order I got was unnecessary - thus making the $8.95 I paid to get it completely wasted. My parking ran out of time. I had to drive in the outer city area which was hugely confusing and I missed my turn about five times in a row because the instructions were not making sense to me, and I'm gonna have to do it all again in a few days time. I was late to my sister's place for babysitting. My niece wasn't very happy to see me either.

Today wasn't a good day. 

With every step that progressed today, I got more and more frustrated and I didn't know how to deal with it at all.

Finally, I lay on the bed next to Bailey as she fought the urge to fall asleep, yelling and crying with tears streaming down her poor little face. I decided to sing.

First it was a lullaby, which managed to stop the crying.

And then somehow, I found myself singing an old hymn - Turn Your Eyes Upon Jesus.

Turn your eyes upon Jesus
Look full on His wonderful face
And the things of the earth
Will grow strangely dim
In the light of His glory and grace

...

Verse after verse, I sang it over and over again, to her and to me.

And when I tried to change it to Ku Mau Cinta Yesus, she gave a whimper and started to cry again, but stopped as soon as I started again on Turn Your Eyes Upon Jesus.

Tears welled in my eyes as I remembered Pastor Russell's message in church yesterday about turning to look at Jesus when we're struggling, and that the more we see Him, the more we become like Him. Be it fear, anger, insufficiency, worry, stress, sickness.. whatever it is, you just have to readjust your gaze, and focus on Him once more.

Tears continued to well as I remembered how Megan sang this over me a few years back when I was going through something else, and how powerfully it spoke to me then too.

I'm writing this now as baby girl is sound asleep in bed, feeling absolutely amazed by the peace upon us both right now after that simple reminder.

Turns out, all we really needed, was to turn our eyes upon Jesus, and let Him be the one to calm the storms within us.

Thank You Papa. :')