Hidup mulia

In medical ward death and dying is part and parcel of my daily work.. I was in orthopedics for 4 months previously and during that time, i never experience patient collapse and died in front of my eye … Of course patient admitted to orthopedics are different compared to those admitted in medical .. most of them are younger and have mild underlying illness such as hypertension or diabetes which are in the early stage ..Few weeks ago I was oncall with 2 other colleages. At arround 12 noon I received a call, a 27 years old lady was admitted. Through the phone the staff told me patient was unstable and has been having difficulty in breathing. I put down the phone and attend to the patient … As I approach her, I saw a young lady gasping for air, swollen all over her body … Its like michelen ghost we see in the ghost buster cartoon … A high flow oxygen mask was put on her and she can still communicate with me .. Her husband was standing besides her with sun glass hangging on his nose .. I was a bit irritated actually .. According to her husband she has been having difficulty in breathing for past 1 week and finally decided to bring her here that day as it become worsen … 5 months ago she was diagnosed with end stage renal failure with nephrotic syndrome and hypertension… Prior to that she had an abortion … Both of her kidney was not functioning and was advised to undergo AV fistula so that hemodialysis can be done.. I’m not sure whose to blame but she refused the AV fistula and op for homiopathy therapy…. Her blood pressure was high and blood investigation showed she had uremia caused by accumulation of urea in her blood, her lungs and abdomen was fill and fluid  … She need peritoneal dialysis urgently  however her coagulation profile was prolonged .. It means if we dialyse her, the procedure may caused and uncontrolled bleeding and she may died of severe bleeding. We plan to transfuse 2 pints of fresh frozen plasma in attemp to fixed her blood defect however during 1st pint of transfusion, she deteriorated, her pupil was sluggish despited of presence of spontaneous breathing and slightly high blood pressure … Soon after that she vomited blood, she started gasping and blood pressure started to drop and death in line was in formed ..   She past away around evening in the presence of husband and family members…

This is one of few death I confronted during my oncall .. Just for the record the management of this patient was done in the presence of my medical officer …

Using or choosing an alternative care is not wrong but defaulting hospital medicine and refusing life saving procedure is a huge sin .. Personally I was angry and disappointed with the husband … But I do realized that people have their own belief and paradigm .. In this group of patient, time talking and lots of patients need to be invested during the first time they came to us 5 months ago … We have miss the boat and people end up dead in front of us .. So many “if” comes to my mind but what different does it make for her … Another patient came and while attending to them, I gaze my eye on her empty bed thinking what if ?

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