Doktor Tak Buat Apa - Apa

7:52 AM

Datang ke klinik dengan luka di kaki yang sudah berbau.
Bila ditanya, baru sehari terjadi. Walaupun nampak seperti sudah seminggu dibiarkan.
Ditanya; “pakcik ada penyakit kencing manis ke sebelum ini?”
Katanya tidak, DOKTOR TAK KATA APA APA PUN.
Tetapi Random Blood Sugar 30 mmol/L. Dalam rekod klinik pula menunjukkan ubat Metformin 1 gram telah dimulakan sejak setahun lalu manakala tarikh temujanji adalah 6 bulan lepas. Default TCA.

Dihantar ke hospital untuk rawatan lanjut. Keputusan untuk memotong bahagian kaki yang busuk telah dibuat. Setelah seminggu di wad, dibenarkan pulang dengan daily dressing.

“Doktor di hospital ada mulakan apa – apa ubat?”
Katanya; DOKTOR TAK PESAN APA – APA PUN
“Yang saya tahu, doktor SURUH POTONG KAKI!”

Bila diteliti surat rujukan ke klinik, pakcik telah dimulakan dengan subcutaneous Insulin. Fungsi buah pinggang pun telah mula rosak. Temujanji untuk bertemu pakar buah pinggang telah diberi, lagi dua minggu.





Telah enam bulan pakcik tak datang untuk temujanji susulan untuk penyakit kencing manis dan darah tinggi. Pada bulan ke tujuh, pakcik datang dengan anaknya.
Tercungap cungap. Kakinya sudah bengkak. Terdapat tanda tanda yang paru parunya dipenuhi air. Kandungan oxygen hanya 80%. Mungkin kah cardiac failure ataupun renal failure? Yang pasti sudah ada fluid overload. Pakcik di hantar ke hospital secepat mungkin.

Sebulan kemudian, pakcik datang lagi ke klinik. Kakinya masih bengkak tetapi tidak seteruk dulu. Bau asap rokok yang kuat keluar dari nafasnya. Menurut nota discaj, pakcik dimasukkan ke CCU kerana serangan jantung.

Cardiprin 100 mg OD
Frusemide 40 mg  BD
Metoprolol 200 mg BD
S/C Insulatard 20 units ON
S/C Actraoid 16 units TDS

Walaubagaimanapun, paras gula nya masih tinggi. Kotak rokok Dunhill masih tak lekang dari poket bajunya.
“Doktor ada pesan apa – apa tak pakcik?” tanya doktor.
DOKTOR TAK BUAT APA – APA. Dia cakap suruh POTONG SALUR DARAH kat jantung. Gila ke apa?!”

Satu bulan seterusnya, pakcik dibawa oleh isterinya. Badannya berpeluh. Nafasnya laju.
Belum sempat dibuat ECG, pakcik tidak sedar. Nafasnya berhenti. Jantung nya berhenti.

CPR.
Intubation.
Adrenaline.



Isteri pakcik menangis teresak esak. Anak – anaknya baru tiba di bilik kecemasan. Semuanya terkejut kerana kehilangan orang disayangi,
Kali ini, DOKTOR TAK BOLEH BUAT APA – APA.


Kisah ini tidak merujuk kepada mana – mana kes yang spesifik tetapi senario begini amat kerap berlaku. 
Renung – renungkan.

MOfrust











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10 comments

  1. negligence about possibility of Alzheimers in old age? think again, especially in geriatric age group.

    ReplyDelete
  2. Poor counseling by health professional?

    ReplyDelete
    Replies
    1. Multiple times? I highly doubt it. He's in denial and hence defaults. That's just my 2 cents.

      Delete
    2. poor counseling? trust me, i have met plenty of diabetes patient, every TCA i gave them the same health education time over time over time until i got bored of it. until they are refusing to see me.

      "pakcik/makcik, ubat jngan lupa makan, sentiasa makan ikut waktu, pakcick/makcik sekarang menghidap kencing manis, darah tinggi, dll, kalau pakcik/makcik x ikut nasihat, boleh dapat kesan sampingan yang lebih teruk, boleh kena stroke, kaki boleh kena potong, dll"

      and yet they still failed to do so, when the situation gone worst, they point their finger at me. so how was that for a poor health counselling?

      Delete
  3. Counselling is an issue..But cannot be denied that sometimes u counsel till the cow flies over the moon also they wud still smoke away like a coal train n eat nasi lemak till eternity.. Pt factor significant as well..

    ReplyDelete
  4. Well, this actually happens before. When I was a houseman and the ward wasn't that busy, I took 1 hour to explain and answer all questions a patient asked me with layman term/ways and drawings. And before we end our conversation, I asked him, do you understand everything I said and do you still have anything to ask, he said no. And then, my specialist came and did rounds, and asked him whether he knows what's going on, he's answer is NO again. I terus pengsan����

    ReplyDelete
  5. After working in Malaysia for close to 20years, I have decided it's the attitude. I have almost given up now!

    ReplyDelete
  6. Dear MO Frust,

    I've been a long time lurker on your exceptionally insightful and opinionated blog but this particular post somehow compelled me to leave a comment on your blog.

    I work as a Medical Officer in the Emergency Department of a government hospital and the end point of the scenario you had described is something that we as frontliners in the ED face almost daily. That are many factors that contribute to non-compliance but I think it all boils down to taking responsibility for one's own health. It's going to take a long time for the majority of Malaysians to be responsible for their own (and their dependents') health which is partly due taking health and healthcare for granted.

    Our healthcare system is highly subsidized which is a good thing as health is a basic right and everyone should have access to affordable i.e. virtually free healthcare. But that also leads to complacency and most of us only become concerned when we become very ill, expecting healthcare providers to perform miracles when it is already too late while we couldn't even be bothered to educate ourselves about the diseases that we are having in the first place.

    Attitude and behavioural change is one of the toughest things to accomplish and I believe that is where we should start. It's much easier to hydrate, start insulin, correct electrolytes and treat the underlying cause in a diabetic patient with DKA than counsel the same patient about lifestyle modifications and compliance to follow-up and medications.

    Modern medicine is too compartmentalize and rarely do we treat patients holistically. Instead, we tend to concentrate more on organs and systems and in the end we can't see the forest for the trees. We are too concentrated on saving a few trees when the forest is burning down around us.

    There is a lot of room for improvement but I feel that the Malaysian healthcare system has the potential to be one of the world's best if only we can put our petty differences aside and work together to ensure the long lasting health and prosperity of Malaysia and her citizens.

    Just my 2 cents and thanks for writing such an awesome medical blog!

    ReplyDelete
  7. adviced patient to take Anti HPT medicine almost 1 year.denial patient.want to try alternative medicine such 1 pill cure everthing hehe.but at last happy seeing the patient start taking antiHypertensive after countless counseling. approach the patient not as doctor but as a son/daughter who want to help him/her.just sharing experience..not all aproach for the advice is the same..

    ReplyDelete

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