A while ago now, in-between the many public holidays that punctuate this time of year, I was in the hospital showing a short term volunteer from the Microbiology lab around the ICU medicine ward. She - R - was keen to talk to the doctors & nurses on ICU medicine about sending more samples for microbiology testing. The lab has been established for almost a year but changing health workers habits, whether that is requesting investigations or prescribing, readers of this blog will appreciate, is rather challenging. R wanted to 'remind' them that they could send blood cultures, CSF, urine, wound swabs etc. They were all sat around, looking very relaxed, watching karaoke so I'm not sure how much was absorbed.
R then requested to look around the ICU ward, before we even got to the first room I could see that this was not a good time for sight-seeing. Through the crack in the door I could see a man Cheyne-stoking (the last breaths of a dying man) with his wife crying over him. The 2 other patients & their relatives were looking on mutely. The nurses & doctors you will recall were sat watching television in the staff room. I expressed that this wasn't a good time to intrude on a dying man's last moment but my non-medical VA & the non-clinical R thought it was fine, she couldn't accept that there was anything seriously wrong with the patient because to her he looked perfectly well.
I went to find Dr L to find out why a man was dying & being ignored by all the staff who were all still sat in the staff room watching bad Cambodian TV. Apparently he had Hepatitis B, liver failure & encephalopathy which would explain why he was jaundiced & in a coma. The wife wanted her children who were 2 hours away to come & be with their dying father but it seemed that this wasn't going to be possible - money & time were both limited.
I went back to explain the situation to R but I found her crying with the inconsolable wife. The man started to vomit blood - I called for some help & without gloves or an apron I rolled the man over by myself to hold him on his side. One could argue this was a pointless intervention but I really can't bear to see an obstructed airway, even in a dying man. My VA has an aversion to body fluids, R & the wife were both paralysed by sobbing & the rest of the relatives passively looked on.
Two student nurses arrived - they saw me trying to help the man to have a semi-dignified death & just started giggling joining the audience mounting now in the door way & ward window consisting of various patients, relatives & monks.
The man died.
The wife became hysterical with grief. R started taking photos of the whole spectacle. It was truly one of the most surreal deaths I have ever been witness to, although it probably will make me sound like a terrible doctor, I have been present at quite a few. R wanted to take photos of the wife with her dead husband & for my VA to take photos of R with the wife & dead husband AND me with them also. My english reserve & sensibilities kicked in. The bereaved wife seemed to be buying it all though so who was I to judge. (R later went & got the photos printed out for the wife to take back to her village, for her & her children.)
Then the wife ran off to cry outside very loudly & telephone her children. Generally here people take pain, suffering & death quietly, it is quite unnerving & so it was a relief to have a physical & auditory response for a change. When she returned R had organised for her to clean & prepare her husband's body. This is something that in the UK would be done by the nursing staff but his widow, me & a short term microbiology volunteer managed to do a reasonable job.
R was crying as much as the wife - her face wet with tears & snot, the wife was clinging to me sobbing onto my shoulder, making my top wet with her tears. The other relatives in the ward even had tears in their eyes by this point & I found myself dry eyed, stood grimly thinking, 'am I emotionally closer to the ICU staff who are still just sat watching TV & snacking in a room 6 metres away?' Surely what was happening in this room was much better than any Korean soap opera could offer them?
Atherosclerosis is hardening of the arteries & as one of my moodscope emails recently told me psychosclerosis is hardening of the attitude. This I believe is definitely an issue here and some times I worry that it may even be contagious.
For the past 6 weeks, since but not directly related to this event, I have cried at least once a day - so I think my tentative self diagnosis of psychosclerosis was premature but I'm willing to accept 'burn-out' instead!
R then requested to look around the ICU ward, before we even got to the first room I could see that this was not a good time for sight-seeing. Through the crack in the door I could see a man Cheyne-stoking (the last breaths of a dying man) with his wife crying over him. The 2 other patients & their relatives were looking on mutely. The nurses & doctors you will recall were sat watching television in the staff room. I expressed that this wasn't a good time to intrude on a dying man's last moment but my non-medical VA & the non-clinical R thought it was fine, she couldn't accept that there was anything seriously wrong with the patient because to her he looked perfectly well.
I went to find Dr L to find out why a man was dying & being ignored by all the staff who were all still sat in the staff room watching bad Cambodian TV. Apparently he had Hepatitis B, liver failure & encephalopathy which would explain why he was jaundiced & in a coma. The wife wanted her children who were 2 hours away to come & be with their dying father but it seemed that this wasn't going to be possible - money & time were both limited.
I went back to explain the situation to R but I found her crying with the inconsolable wife. The man started to vomit blood - I called for some help & without gloves or an apron I rolled the man over by myself to hold him on his side. One could argue this was a pointless intervention but I really can't bear to see an obstructed airway, even in a dying man. My VA has an aversion to body fluids, R & the wife were both paralysed by sobbing & the rest of the relatives passively looked on.
Two student nurses arrived - they saw me trying to help the man to have a semi-dignified death & just started giggling joining the audience mounting now in the door way & ward window consisting of various patients, relatives & monks.
The man died.
The wife became hysterical with grief. R started taking photos of the whole spectacle. It was truly one of the most surreal deaths I have ever been witness to, although it probably will make me sound like a terrible doctor, I have been present at quite a few. R wanted to take photos of the wife with her dead husband & for my VA to take photos of R with the wife & dead husband AND me with them also. My english reserve & sensibilities kicked in. The bereaved wife seemed to be buying it all though so who was I to judge. (R later went & got the photos printed out for the wife to take back to her village, for her & her children.)
Then the wife ran off to cry outside very loudly & telephone her children. Generally here people take pain, suffering & death quietly, it is quite unnerving & so it was a relief to have a physical & auditory response for a change. When she returned R had organised for her to clean & prepare her husband's body. This is something that in the UK would be done by the nursing staff but his widow, me & a short term microbiology volunteer managed to do a reasonable job.
R was crying as much as the wife - her face wet with tears & snot, the wife was clinging to me sobbing onto my shoulder, making my top wet with her tears. The other relatives in the ward even had tears in their eyes by this point & I found myself dry eyed, stood grimly thinking, 'am I emotionally closer to the ICU staff who are still just sat watching TV & snacking in a room 6 metres away?' Surely what was happening in this room was much better than any Korean soap opera could offer them?
Atherosclerosis is hardening of the arteries & as one of my moodscope emails recently told me psychosclerosis is hardening of the attitude. This I believe is definitely an issue here and some times I worry that it may even be contagious.
For the past 6 weeks, since but not directly related to this event, I have cried at least once a day - so I think my tentative self diagnosis of psychosclerosis was premature but I'm willing to accept 'burn-out' instead!
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