Tuesday, August 12, 2008

Recalcitrant Patient

*Names and identities changed in this article. Coming next: The nuances of keeping clean, and cleaning...

'Morning Mr Liew', greets the consultant running the morning rounds. 

Mr Liew turned over to look at us quizzically, his head still nesting in the comfort of pillow. Peering at us intensely through fatigued eyelids that refused to hold up, he nodded at us once, and went back in search of deep slumber. 

Out of luck. The registrar goes on to pat at his shoulder repeatedly, much to his dismay. 

'Afebrile, vitals stable. Sats 99% at room air. Input and output...' I mumble as i read the clinical chart, while the MO(medical officer) scribbles at the case notes. 

I glance about the bed in the meantime, sizing up the patient in the clinical sense. Mr Liew is a new patient that was admitted while i was away so i have no knowledge of his diagnosis at all. 

A middle age chinese man, unkempt and unshaven, his appearance tells a tale of someone who did not have the favours of life shining upon him. His coarse features have a certain air of rebelliousness. Wearing a double chin and a sizeable beer belly, he probably was not too scrupulous about his health. Grinning at us with a display of yellow-stained teeth, he must have smoked like a chimney. I wonder what his problem is. 

The consultant goes to the end of bed and begins pulling the carefully tucked-in blanket out. 

Mr Liew shifts his weight around lazily as the blanket is being pulled away. I notice something moving in the pocket of his patient shirt. 

Through the thin yellow fabric, i can make out the rectangular shape of the object. Unable to tell what it is on first look, i turned my attention to his left foot, which is much more relevant than whatever that nestles in his pocket. 

He has had a transmetatarsal amputation (think chopping all toes and half of the foot transversely) of his left foot, exposing an array of cross-sectional bones and tendons buried within flesh. 

Being a patient of my team of doctors, this can only mean he has peripheral arterial disease, a condition where arteries in the peripheries (especially lower limbs) get clogged up with cholesterol or narrowed, causing the toes and feet to die off. 

The typical patient is an elderly man/woman with poorly controlled diabetes, hypertension, high cholesterol, and smokes too. However Mr Liew is only 40 years old. 

Listening to the conversation between the consultant and patient, i am shocked to discover that Mr Liew had an episode of cardiac arrest during his current hospital stay too. 

40 years old. That's really too young to have so many health issues. 

'When can i go home?' The patient asks impatiently, and rather animatedly as we inspect the condition of the amputated foot. The consultant has a hard time trying to convince him that he is not well enough to go home. 

Holding a sterile dressing towel in one hand, i lift whatever is left of his left foot up with another hand. As i lift his left foot high up to slide in the dressing towel, the mysterious rectangular object in his pocket slides out. I feel the same surprise that punters winning jackpot must have felt, minus the thrill. 

It's a box of cigarette, complete with a pictorial warning of a gangrenous foot. How fitting! 

I can literally see dark clouds hovering over the consultant's eyebrows. I can almost make out the sound of thunder as he chastises the patient for smoking. I steal a look at the sky outside, thank goodness it is a clear day with plenty of sunshine. 

Mr Liew looks at us defiantly, and shrugs his shoulders. I swear all of us look really defeated at that moment. Sometimes all the advances in modern medicine seem so futile. 

Why smoke again? When it has caused you to lose half of your foot? When it has made your heart stop once? 

I have no answer to that, and I hate to admit that i see traces of my friends in Mr Liew, friends that i care about. 

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