The Depth of Death

Death has been a topic which people discussed with a hush voice. It is a word that you shouldn't use during festive season as people will scowl at you. Yet I had written a handful of blogs regarding death.

The fundamental rule: Everyone must go through death at least once. Some people had escaped death, coming back to tell tales about near dying experience. Which brings to the fundamental rule No 2: You can delay death, to the extend of prolonging death, but you can't totally avoid death. Patient with brain death can be hooked on the ventilator machine. The can breath. They have heart beat. But once without the mechanical support, he or she is very vulnerable.

I don't like death. It brings tears to people, it breaks the heart. But I faced with death, day in and out. No matter what you do, you just can't avoid death. If you face death like a journey that one must endure, then death may come with less pain.

One good friend of my parents were diagnosed with advance breast cancer about a year ago, competed surgery and chemotherapy. About 2 weeks back, she had a fall one day at home and was brought to the a private hospital. CT scan of brain were done, showing multiple metastasis to the brain. Nothing curative were able to be done at that moment. Family members were desperate, seeking for second opinion, asking for miracle to happen. Everyone seems to know the diagnosis except the patient herself. She was kept from the truth, fearing that the truth will burden her already troubled mind. They brought her to hospital, asking doctors to do further active management for her.

I believe this is not the first case. Most of us face death with fear, only few have courage to stand up. More often than not, we often omit how the patient feel with regards to her own body. If you are the patient, lying on the death bed, will you don't want to know what is wrong with you? Will you like the truth to be buried with you to the grave? Most of the time, the patient is not blind, death or dump to be not able to guess what is wrong with her own body. Yet, she has no right towards her own body when it comes to death? What if the patient wish to meet certain people, to forgive some relatives and to repay some old dept before she dies, wouldn't she feel regretted for not able to do so? If she wish to donate her organs to benefit many, we would have selfishly denies her to do so. Death is not as simple as close your eyes. There are many legal matters involved. For example, bank accounts, saving bonds and funds that needs to be transfered to some one else. These things, although small, will be a big hassle for those who live on.

Please, do not deny the patient from the truth. It hurts me every time I faced with this situation. When you come to make decision for other people, always put yourself in other people's shoe. Do you want to be treated that way? If the answer is no, please don't do it on other people. You have absolutely no rights over other people.

Making Heaven Out of Hell

Lately, I had been having conflicts with my new department. Being accused for the things that I didn't do, senior officer talking bad behind us, colleague that is very calculative and no team work spirits and many more. All these had been burdening me quite a lot lately, to the extend of almost feeling depressed.

Yesterday, I had a revelation...

I was walking down the alleyway towards the cafeteria. Suddenly a thought stuck me... I was making my own living hell. Why not make a heaven out of it?

Now, I am working in one of the wards. My senior officer in the ward is what a common people would call 'bitch'. She was the kind of people that likes to gossip. She has a couple of horrible gossips partner, that not only tell nothing but lies, but also love to wreak havoc. What makes the matter worse is she is also likes to report to the big boss regarding small matters, and exaggerates things. Her mood swing is as fast as the F1 racing machines.

Lately, I had been called to an inquiry, no less thanks to her. She had been telling lies behind the big boss. Glad the things I did was acceptable under standard medical practice, I was spared from getting a punishment.

How can I clear up this mess?

First, make truce with her, my senior officer. I said to myself, why would my mood be affected by someone that is so less important to me? She can curse, talk bad, laugh about me, but she can't control the way I feel. Follow her order, my day will be fine. Against her, she makes the hell out of me. So you tell me, which way I should go?

Being nice to people doesn't always equals to people being nice to you. There are people who takes advantage on other people. I notice of late, there are colleague that fits into the criteria above.

She came late to work. She doesn't want to clerk cases. She does not want to present to a consultant during rounds. She does not like to wake up during night call. In the end, who needs to cover her? Me. Who needs to clerk case? Me. Who needs to present cases? Me. All me, and me and just me. Naturally, I was up in smoke. How is it justified that who of us get paid but only one get to work?

And again, why should I be not happy for some other people's problem? If she doesn't like to learn, it is her problem. If she doesn't want to work, it is her problem. The more I work, the more I gain, in terms of knowledge, experience and improves on my patient relationship. At least, I know the hard-earned money I get at the end of the month are worthy.

Working is fun, only if you can make heaven out of the living hell.

The Unexpected Death

I think, almost every mother bearing a child came to my clinic would expect to bring back a child when they were discharged. No one, absolutely no one expects the others.

Today, I faced with a difficult situation.

8.27AM, an expecting mother came to my clinic because she is feeling pain at the lower abdomen and the contraction was getting stronger. After a quick examination by my fellow friend, she was already in the advance stage of labour. So we pushed her to labour room.

I was the most senior house officer at that time. My friend was a tagging house officer since she just joined the department. After a while, the medical student rushed out for my assistance. She looked scare. So without wasting any time, I rushed to the labour room.

The atmosphere was cold. Nobody speaks. Everyone looked at the newly delivered flesh laying motionless on the green sheet. His body, swollen up twice his size. His face plethoric and the skin peeled of like plastic cover, exposing the red flesh. The umbilical cord was snapped into half. It was an awful sight.

The mother looked at me, half expecting the outcome of the labour. "How was my baby, Doctor Goh?"

"Did you go and check you baby well being lately?" I asked.

"I felt the quickening lessen throughout this week, but there was contractions. People said contraction was due to the baby moving..." She said.

Then came the hardest moment in my career, breaking bad news.

"Madam, I am sorry to say that you newborn is a stillbirth. He must have died quite sometime in your uterus. I am really sorry..."

Then she cried. I did not try to console her. This was grief which she must go through, so Elizabeth Kubler Ross said.

I offered her the opportunity to see the child. She could not bear the sight of a dead child. Must have been a great loss to her, her family and her love life. And I had to break the news to the husband as well, which he accepted quite well.

I am not good with death counseling. There is still a long way to go.

My Teacher, Then My Patient, Then My Teacher Again

Nothing touched me so much compared to this.

One fine day, my brother rang me up, told me that a patient had handed a note to him mistakenly, (as we share same surname). It was a small piece or parchment, apparent scribbled in a hurry. Each and every words were misaligned. After reading the note, there was a warmness spreading from the heart. Thus my tiredness bubbles. At least I know there is love in this world.

Read on for the content of the note:


Sometimes, a word of gratitude is more valuable than expensive gifts. His gratitude lights up the healing heart of mine.

Working is fun, all along.

A Different Perspective

Staying grounded for too long for me, is not good.

Sometimes, I need to fly. Above the ground more than 30,000 feet. Then you will understand what is perspective. I like the clouds beneath my feet. The sky, bluest of the blue, melt with the horizon. The lush green of the forest, dotted with buildings, and the river snakes around to reach the open sea. The sea, seems to be permanently marked by the ripples, and the ship frozen over the blue sea.

That is the way with life. Problems seems magnified when we look at it heads on. When we stand at a different perspective, sometimes the solutions seems to be the there in front of our eyes.

I just love flying.

Reflections: Medical Posting

Four months had passed, just in a blink of eye.

I had completed my first rotation in Medicine posting. It seems like yesterday, a fresh grad, half trembling, half confused, make his steps into this biggest hospital in the biggest state of Peninsular. Countless of sleepless night, exhaustions beyond words, pressure from superiors, ragging from peers, finally, yes finally I reached the end of the steps.

I learned a lot. Stuffs that I don't learn throughout schooling years. Stuff like interpersonal relationship, teamwork, overtime, and overwork. Not that I am not expecting all this to come, but the culture shock it gave to me. If I wasn't strong enough, I would have been a total failure. I would not be considered bragging when I said I am excelling in Medical posting. Most of the supervisors gave me an approving nod. (some even going to the stage to extend me so to help them out with work) I think to summarize it all, hardworking and honesty are the values that everyone values.


Next, I am going into Obstetric and Gynaecology. Hope I still have the passion to go on. I just love this job.

A Tale of Resurection

Today miracle happen to me.

After more than 30 resuscitations, today I am able to revive a patient, after he went into asystole.

He is a 70 year-old Malay, came in with congestive heart failure, very poor ejection fraction, and came in with fluid overload. He had pitting oedema up to knee, shortness of breath and congested lungs.

Initially, he was well. After going to toilet, his son rushed to me, when I was taking blood for another patient. He had fainted in the toilet. He fell squarely behind the toilet door, obstructing the only way out. Fifteen minutes passed of struggling to moved him away from the door. When I able to get to him, he was already unresponsive. No pulse. My adrenaline gets into action.

Immediately he was pushed into the acute bed. Cardiac monitoring put on. Flat line, no pulse. Barely any effective breathing activity. CPR started. After about 3 minutes, he regain pulse, with an extremely bradycardic pulse that is. Medication to increase blood pressure started. Blood pressure maintained. He was intubated and ventilated.

It is not all lost hope when the patient went into asystole (or not heart beat). But the chances that we are dealing is pretty slim. For an average Joe with no medical complication, the chances or revival is about 15%. However, the percentage dropped to almost 0 if the patient is having multiple medical illness. On top of that, the patient after being revived, requires intubation, ventilation, Intensive Care Unit admission and nontheless complications to multiple organs. That is why we always take into consideration patient's wishes for resuscitation and family views with regards of this matter. Sometimes, it is not prolonging the life, but prolonging death.

Think about it.