Time

If only I have more than 24 hours.

But here's a note to myself, keep going. You're almost there.

Hospital Diaries : Locked in Syndrome

Have you ever imagined if your soul is locked inside your body, and you can't express yourself except only by blinking? Imagine you can't move your limbs even if you want, imagine if you wanted to talk so much, but words could not come out of your mouth, imagine when people attempt to feed you but you could not open your mouth, move your tongue. Imagine living your life in a container.

I saw a patient who was diagnosed with locked in syndrome this week. When I first saw Mr. M, he was lying on the bed, with a tracheostomy, and a nasogastric tube intact. I talked to him, and he could respond only by blinking his eye. And that is the only way you communicate with patients with locked in syndrome, and that has been the way of communication for the entire week. I would ask a question, and a yes would be two blinks and a no would be one blink. It is not easy getting the blinks right, because sometimes you never know whether one would be blinking spontaneously. And to be honest, from his gaze I know he didn't like me from the start, because I would sense this kind of angry gaze from his eyes, and I know he doesn't like me touching him. But, I started to pay attention at the little things he need, and do simple things for him, such as : wiping saliva off his mouth, helping to notice if he had any skin infections, and  helping him to wipe of the mucus secretions that came off his tracheostomy tube. Eventually, I think we are actually communicating, because I sometimes he would refuse to do my commands and I would ask : Why ? Does it hurt? and he would blink two times. And sometimes after I finish my interview, I would ask - do you want me to call the nurse ? and he would blink two times, and after that, I asked can you tell me why? and I would list out a series of options for him, and he would blink two times when I got it right, and I would reconfirm it. It turns out to be a two way communication in the end, and I am glad that I did not give up on him. At times, I would give him words of encouragement, and tell him to be strong. I know it is hard, and I would see tears lingering from his eyes at times.

What they say in medicine is true : it is never made for you to feel good about yourself, but it is to make the patient feel good and make them feel better, and by paying attention to little things, you can actually make a big difference. Communication is a two way street : you listen, and you respond with care, and things will work out in the end.

Hospital Diaries : apraxia

So I saw a young man today who presented to the hospital following a motor vehicle accident. He could not speak following his accident, and doesn't seem to be comprehending much either. He could vocalize, but couldn't speak spontaneously. He could repeat the word "pen", but couldn't identify a pen. When asked to smile, he would simply repeat "smile smile smile", for he does not understand the commands. It was devastating if you imagine your soul being trapped inside a body, in which you are not sure what to do with. All your previous memories essential to your survival was wiped out, ie he would not be able to use any tools presented. This is what they call ideomotor apraxia.

I dozed off while writing this yesterday, and here is an update : the patient was able to hold a pen and use it to write a word (that doesn't make sense), but was unable to write a full sentence, still could not name a pen, but is able to talk now. I am so happy for him, and I hope he will be back to his functional state soon :)

At times when you question yourself if this journey is worthy of all the sacrifices that you make, having witnessed such miracles would convince you that this is the right path. Now just keep going :)

Shit pies ! :)

I guess work is the only way that can maintain my sanity at this moment. I can't explain what is going on in my life right now, but I know this is not the end of the journey. I  believe that everything happens for a reason, and if life throws shit at you, just make them awesome shit pies.

Hospital diaries : Multiple sclerosis

Knock knock. An old man pushing a young man bound to a wheelchair entered the room. The first thing I noted was a bag for containing urine hanging out of the man's legs. It was a follow up session for this young gentleman with multiple sclerosis, who had been diagnosed at age of 22, but the specific variant of multiple sclerosis that he had was a bad one and the disease progressed beyond its control. It is called tumefactive multiple sclerosis. 

It is the first time I saw a male patient with multiple sclerosis, as they are more common amongst females. To my surprise, it is 1 out of the 3 cases that they saw in the hospital. How lucky I am. This gentleman had a suprapubic catheter placed because he had developed a fistula (meaning a connection between his bladder and his bowel), and couldn't urinate through the normal route (ie. the urethra). He also developed a sacral sore which I am guessing from the pressure sores from having been wheelchair bound for the past few years. As a result of his sacral sore, he had to have a stoma inserted in his bowel for feces elimination. He spent his past year in ICU undergoing all sorts of operation to get his catheter and stoma in place. 

The thoughts that came into my mind was : I couldn't imagine what sort of life I would be living if I couldn't walk, couldn't talk, couldn't urinate / defecate and had to rely on other people for the rest of my life. I salute the father as well, for he appeared cheerful, and was constantly reassuring his son throughout the interview. I am not that brave to be able to dwell through whatever that the gentleman is facing, and I laughed at things that I usually fret about / worry about. What are my problems compared to theirs anyway?