Saturday, June 28, 2008

Healing is a painful experience: Mum's home, post-CABG

Most of us doctors take it for granted that humans can and should heal rather quickly. At least we expect the human body to recover as physiology dictates, and as science predicts--logically and systematically, minus the emotional and psychological underpinnings...

As doctors, we have always had to maintain that detached feel when approaching our patients, no matter how close and comfortable some of them may have become after years of intimate encounter and trust. We empathise as deeply as we can, but try to remain as dispassionate and as objective as possible.

Although a paternalistic approach of the doctor-patient relationship has been frowned upon of late, there is some truth that a slight top-down relationship can help establish a better patient outcome in some therapeutic exercises. Of course, we have to ensure that every patient should be appropriately and sufficiently informed to the best of his/her ability to understand.

We try and maintain a professional distance and authority so that the doctor-patient relationship can be put on a better and surer footing. Many patients still accept the prerogative and trained wisdom of physicians to do the right and proper thing, i.e. to bring about a healing process.

Most times we try and project a professionalism which because of our training and expertise, we can then exude that confidence that the patient and his/her relatives can trust and believe in.

In many instances, this slightly asymmetric relationship can help build a stronger physician authority which then makes informed consent and certain medical decisions easier to arrive at. But this is not to say that, we should bully our patients into making hasty decisions for which they have cause to regret later on.

Nevertheless, this has made many of us doctors into sometimes too distant and aloof partners, from the point of view of our patients' suffering. And because of this we can be rather brusque and sometimes downright tetchy when our patients appear to be slow in accepting our recommendations; and when they do, they appear to be slow or fearful from wanting to ambulate or move/exercise too quickly especially after an operation.

We are all brought up with the belief that the quicker the efforts to return to normal activity (within reason and capacity), the more rapid and complete the recuperation process would be. And so we make it our religious duty to impose stringent rehabilitative commands that our patients do as we tell them to, so that they can improve the way we expect them to do so.

Yet very often, many of us forget that there is a body and soul out there, trying to cope with a sanctioned 'assault' on a part or parts of the body, which may be more extensively and exquisitely injured than we think.

But for most of us, even as doctors we are spared the real-life experience of the actual pain and suffering, that some of our patients go through. It is said quite correctly that we can never feel enough unless we actually experience exactly or more of the same...

It is difficult to imagine how the human body recovers, and at rather wondrous and fantastical speed at that. It has been a long while now, but recently, I have been personally privy to just such an experience.

My mum underwent coronary bypass surgery exactly 3 weeks ago at the age of nearly 77 years. That she has come out with flying colours is testimony to her tenacity and iron will to live. At this elderly age it was already a very difficult decision to make to undergo such a major surgery. As children (and worse as a doctor!), we were all very aware of the inherent unknowns associated with bypass surgery at such an age--the risks to the brain, the kidneys, the limbs, the lungs, etc...

But thank God, she not only survived it, she had a couple of complications to boot, which piled up the tension for us, as we waited with bated breath, the unfolding of her pulse-raising untoward events (significant pleural effusion requiring a midnight chest tube insertion, and re-suturing of her thigh wounds from excessive haematoma formation), en route to her final discharge from the hospital.

Here, I must acknowledge and thank the dedicated doctors and nursing staff of Pantai Medical Centre, Bangsar, KL, who had to work tirelessly and under such stress (of looking after a rather anxious and truculent colleague's mother!).

Dr. Arunachalam and Datuk Dr. Zainal Abidin Hamid (cardiac surgeon and cardiologist extraordinaire, respectively, whom I have known and worked with for some 20 years since HKL-days!), Dr. Sylvian Dass, anaesthesiologist and friend, who painstakingly ensured that her anaesthesia and sedation was just spot on, and second surgeon, Dr. Syed Mohd Adeeb, for superlative support. I know that midnight calls are tough on any doctor, but your timely and urgent interventions certainly helped smooth the way of my mother's road to recovery!

The ICU staff and ward staff of D2 were simply fabulous and attentive, despite the ceaseless distressful demands of the very ill patients under their charge. Words alone cannot express my family's gratitude for a job well-done and all the singular care you have all so selflessly extended to my mother. Thanks a million!

Having said this, I now turn to the recovery phase, which I am now fully aware can be very trying and hugely difficult for many a patient! My mother certainly tried to do as she has been 'commanded'--deep breathing exercises, arm and leg exercises, ambulation attempts, self-attempts at personal hygiene, etc.

But every one of these is especially harrowing and painful--the sternotomy site remains bone-crunchingly sore (aggravated by every breath and cough!), and the leg wounds from the venous graft harvesting, are deep cuts which continue to lacerate with each movement! And yet, we urge and exhort that these be carried out repeatedly, to supersede the pain threshold, all in the name of good rehabilitation!

That my mum has always had a higher than usual pain threshold previously, only makes me now comprehend the exquisite pain levels that she has to undergo doggedly, in her resolute will to recover as quickly as possible so as not to burden us her children, any longer than necessary!

But it is also nice to see that within a couple of weeks, her surgical scars at least outwardly has healed so finely, with only intermittent scabs to belie the healing wound; and her haematomas and extensive bruising are now receding... Her breathing still needs more consistent work, and she has to gain her confidence that her many wounds will not dehisce or open up, that her post-op exhaustion, asthenia and mood swings need to be overcome...

Most importantly, her fainting spells and chest tightness which had accompanied her earlier disease and quite incapacitated her, appear to have become things of the past, i.e. her bypass grafts must be functioning well, thank goodness! From now on, it should be all smoothly downhill; but it has been an excruciating experience, which hopefully will be replaced by fonder memories of being well and active again.

From a personal perspective, I have learnt that as doctors, we have to feel and experience more intimately, so that we can understand the legitimate fears and pain of our patients when we recommend surgery or therapeutic procedures, which may be more than has been bargained for.

Importantly, we have to always consider the back-up support of family members, who play an extraordinary role in helping physically and emotionally our more dependent and older patients recuperate. My dad, sisters and brothers, wife and children, nieces and nephews have contributed immensely towards making mum feel good again.

Also, it has renewed an uncommon bond amongst us, which has strengthened our extended family relationship and dynamics so much better--something which would have been impossible, without this crisis. Simply because, we have each of us so many personal things to do, we're too busy with our own lives, despite the fact that we still gather and meet for a few days every year.

But we often fail to connect purposefully for something more ethereal and familial, which many consider as marginal and insufficiently important--that especial relationship which telescopes the time capsules of our historically crossed paths as brothers and sisters, and parents.

I am glad we all had some fond and occasionally tacky reminiscences, singular memories that can perhaps one day fill a book of experiences for our future generations...


lucia said...

Well said, big bro. Wow you do have a way with words. Took me some time to get back to my blog and read yours, but better late than never. It has been a great experience for all of us. Thanks for being there with us all.

Dreamer said...

Hi Dr. Quek,

Great to know your mom's getting on well. Enjoy reading your insightful blogs thus far; the passion for what you stand for personally and professionaly certainly shines through. Take care.