Tuesday, September 18, 2018

Empathy in Adversity


      “Empathy is about finding echoes of another person in yourself” – Mohsin Hamid


    Around 8 months in the hospital, my body was still weak and my legs were still painful but I was starting to be able to stand long enough to be transferred to a wheelchair. One evening, my sister put me on the wheel chair to visit the nearby convenience store located at the hospital.

      As she was about to leave me outside and enter into the store alone (the store was narrow and filled with goods, hence it was not convenient to bring the wheelchair inside), a tall Malay boy in his late teens or early twenties came out of the convenience store. Suddenly, he stopped walking and started to stare at me. Then he approached me.

      I noticed that his head was misshapen, had stitches and was dented at one side, an indication that he had undergone a brain surgery.

       He looked curious, “What happened to you?” while pointing to my head which was covered in bandage. 

       I was startled by his blunt and direct question.
       “She was burnt”, my sister replied.
       I could feel my sister was hesitating to leave me with this boy outside of the shop.
       Waving my hand towards my sister, “Don’t worry, I will be OK. You can go in”.
       However, my sister was still in a protective mode.
       Before entering into the shop, she gave a warning to the boy. 
“You can talk to my sister but don’t touch her, there are a lot of germs”. She was not actually trying to scare him, I was having MRSA infections (a type of super bacteria that is resistant to common antibiotics) every now and then. 
       I narrated to the boy about the gas explosion. He then asked, “How long have you been in the hospital?”.                                           
       I replied, “Around 8 months”.   
       Suddenly, I could see tears coming out from his eyes falling to his cheeks.
       “Don’t cry”, I said to him without thinking and started feeling emotional myself.
       I then asked, “How long have you been in the hospital?”
      Wiping his tears away, “3 months” he answered.
      At that moment, there was a short silence. 
     Although our sickness and pain may not be the same, it felt like there was a sharing and bonding between us, a connection of suffering between 2 strangers.
      Trying to comfort me, and also perhaps comforting himself, he said, “have patience”. At the same time, a woman came out of the convenience store and he quietly followed her.  
      A person who has suffered is able to relate and show empathy towards those who are suffering. I find this true in hospitals, especially among the patients.















   
      










        























Tuesday, September 11, 2018

Handling Pain


          Last week, social medias and local newspapers were abuzz with news of a petrol bomb attack by a mentally unstable man at a local private hospital. A few people suffered burns including a doctor and a nurse.  Read news here
          It really pains me to read such a story. I empathise and feel sorry for those injured as I know the pain that they will be going through in the process of healing and recovery.

A burn patient may undergo a number of procedures such as wound debridement, skin grafting and dressing changes, all of which contribute to the pain experience.

The pain after the burn, is one of the most painful thing that we can experience as our pain receptors are all at our skin. This is especially true for 2nd degree burns. As my sister puts it, “It will make a grown man cry”. And this is true at the burn ward where every morning, during dressing time, shouts of pain and crying can be heard. It is the most stressful and painful time of the day.


Honestly, I am not really good at handling pain. I kept getting MRSA (a strain of bacteria that is resistant to antibiotics), in the burn ward and it was hampering my healing. My wounds would heal and break down again with infections. This cycle happened many times and was truly a very trying period for me. Sometimes I would wonder, when will my suffering end?

A few months after I was admitted at the burn ward, a pilot from the air force was admitted as a result of a plane crash. I took the chance to talk to him, hoping to get some tips on how to withstand the daily pain. Surely someone from the military would have a better technique in withstanding pain?

The pilot replied, “There is no special technique. Just bear with it”. 

I was surprised and puzzled by his answer. Surely there must be something different that the military is doing as their trainings are physically exhausting and mentally draining. Was it a military secret?

The pilot informed me that his burns were the most painful thing that he had ever experienced. Even though he had some cuts and wounds during his military training, it was nothing compared to his current burns. That wasn’t something that I expected or wanted to hear at that time as I was also suffering from my own pain.

            Pain is definitely not easy to bear. However, during my stay at the burn ward, I found a few ways to manage it:- 

          
         
  1) If it is really painful during dressing, ask the plastic doctors for painkillers to be allowed before dressing. Make sure it is written down in the file. The nurses will not give you the painkillers before dressing unless it is clearly stated there.




2)      Take a deep breath during dressing when you know that the nurses are going to clean the painful area.



3)      Prayers can help to focus your mind on something else other than the pain. If you can talk, gossip or joke with the nurses, that will help too.




4)      A friend reminded me not to project my past pain to my current pain. Experience the pain as it is in the present. It may be less painful or not. The aim is not to bring previous trauma of the pain to the current situation.

     

5)      My sister emphasised that we need to look at the goal and not the pain. If something needs to be done, just do it. Well, easier said than done, especially when you are in pain.



6)      When all the above ends up in failure, don’t be embarrassed to scream, shout and cry (just don’t physically hurt the nurses). It is ok and understandable. Letting out your true feelings is better than repressing and pretending to be brave about it.



Don’t lose hope. Always remember that the pain is temporary. It may take some months or years to heal but it will definitely improve with time. 

Monday, September 3, 2018

Man’s Search For Meaning

            During my stay in the ICU, I couldn’t remember any of the self-motivational books that I have read before my gas explosion accident that could help in my situation. The only book that I could recall at that time was some bits and pieces from “Man’s Search for Meaning” by Viktor Frankl. This book chronicles the experience of the writer as a prisoner in a few concentration camps including Auschwitz during World War 2.


                                                            Image Source: Amazon 



Trying to recollect what was read previously, I was reminded that the right love and hope is crucial for prisoners of war. Being dependent on others for my every needs and basic necessities, confined to the hospital bed, it does feel like I am a prisoner instead of a patient.  Immobile and at the mercy of others. Pain inflicted at every dressing change.

I recalled that during one cold icy night, when the prisoners were forced to walk in the forest to the worksite, Viktor Frankl remembered his wife to sustain him throughout the exhausting long walk. Excerpt from the book:



“My mind still clung to the image of my wife. A thought crossed my mind: I didn't even know if she were still alive. I knew only one thing—which I have learned well by now: Love goes very far beyond the physical person of the beloved. It finds its deepest meaning in his spiritual being, his inner self. Whether or not he is actually present, whether or not he is still alive at all, ceases somehow to be of importance."




Viktor Frankl (Image Source: Wikipedia)


Remembering that love is important for survival, I reminded myself that I am indeed lucky that my parents and sister are alive and that I do not even have to imagine that they are alive. That my situation was definitely better than what was faced by the writer.

In the concentration camp, the intellectuals or those who frequently used their brain for a living, outlived those who does labour work or jobs which requires less thinking, even though the latter initially started in a physically stronger state. I remembered telling myself that my mental faculty needs to be in good shape. Luckily, I have my sister who visited me every day and constantly gave me ideas and questions to jog my memory.
            
             In Viktor Frankl’s book, “ Nietzsche's words, "He who has a why to live for can bear with almost any how".

             For Viktor Frankl, choosing the right hope is very important for survival, especially with regards to future, “The prisoner who had lost faith in the future—his future —was doomed. With his loss of belief in the future, he also lost his spiritual hold; he let himself decline and became subject to mental and physical decay.”

             In his book, he illustrated the story of his senior block warden who had a strange dream that the war will be over by 30th March 1945, he was full of hope and convinced that he was right. However, as the date drew nearer it was unlikely that they would be free on that date. On the said date, the senior block warden became delirious and lost consciousness. On the 31st March 1945, he was dead and to all outward appearances, he had died of typhus.

           This book contains nuggets of wisdom which arises from the suffering of the writer and those that he had crossed path with. Despite the horror and atrocities of war, the writer could find it in himself to bring out the humanity and courage within him and see the same from others as well.  I sincerely feel that everyone should read this book at least once in their lifetime as it is one of those books that is indeed worth reading.

          In my mind, I have already been saved twice, the first time was during the explosion itself when I felt something had shielded me during the blast, especially my head area. The second time was in the ICU, fighting between life and death, when I thought I was dreaming and heard a voice calling me back to my body, “Come on, come on, take your responsibility”.

I know for certain in my heart that God had saved me from a more terrible fate. I have yet to know the full meaning of the words, but I do know that one of my responsibility is to live this life. Not to give up on myself that easily. That gives me hope to continue on living as I have been given a second chance or even a third chance to live. Life is indeed precious.


Monday, August 27, 2018

Do Not Ignore The Burns On Your Skin

            As a child, I was not afraid of fire. Every Chinese New Year, I had my fair share of playing with an assortment of fireworks with my sister and all the other children in the neighbourhood. Some were really fire hazardous such as firecrackers and the rocket.  During lantern festival, we would play with those paper lanterns and also had fun melting the mixture of the extra candles with fire.

            During my youth, I had my fair share of burning rubbish at the garden of my home and also helped out with starting barbeques using inflammable materials.  



Looking back, I was quite ignorant of the dangers of being burn and this applies to most Malaysians as well.
 Most of us are not aware that burn injuries can be complicated and difficult to heal depending on the degree of the burn. I’m not in the medical field, so my sharing below is just a simple explanation of the severity of the burn for the ordinary folks to understand better.
     In order to determine the severity of the burn, 2 factors will be taken into account:-
A)     How deep is the burn area
B)     The total body surface area (aka TBSA)

A)    Depth of burn area

a)      First Degree Burns - burn injury where the surface of the skin is damaged, however the epidermis (the first layer of skin) is still intact, and able to perform its functions. Also known as superficial burn

b)      Second Degree Burns- the burn has extended through the epidermis and also burn through the dermis (the second layer of skin). The skin is unable to protect itself, prone to infections and there is a loss of skin function to regulate body temperature. As the nerves are also located in this area, Second Degree burns are also the most painful. Indications of burns that have reach this layer is when there are blisters forming which shows epidermis has broken
c)    Third Degree Burns – the burn has destroyed the epidermis and dermis area, in some situation the patient may not feel anything as the nerves are dead. It can go up to the fatty tissue, muscle and in some situation, bones can be seen.

                          Image source: The Reader’s Digest Medical Question & Answer Book

     B)    The total body surface area

           From what I have read so far, this differs from country to country and the method used in the old days differs from now. Generally, the body will be divided into sections and each section will be given a percentage, it that area has 2nd to 3rd degree burn, it will be calculated and added. 
As a person who has undergone 2nd and 3rd degree burn with 80% TBSA, it worries me to see that many Malaysians are actually ignorant when it comes to burn injuries. 
When I was a patient at the burn ward, I have seen so many patients coming in and out for different types of burns. I noticed that many patients who came into the ward were burn by hot water while pouring out water from kettle or hot oil while frying food. Some of them had initially refused to see the doctor and thought that the burn was not serious. While others choose to put some natural remedy instead, by the time they were admitted, the burn area has gotten worse.  
Sometimes, even doctors (general practitioners) may not realised the seriousness of the burn. There was a patient that I met during my stay at the burn ward, whom I shall refer to as patient A, she informed me that she was burn by hot water when she accidentally spilled boiling water on herself while preparing a hot drink. She went to see a doctor in Kedah and her burn area was cleanse and bandaged. As she had to return to Penang at that time, for work, she asked the doctor to refer her to the Penang General Hospital for the next appointment.
During the appointment with the doctor in Penang, around a week later, she was shocked when the doctor told her that she had to be admitted to the hospital right away and that merely bandaging will not do. She was so afraid when the plastic doctor told her that she would have to undergo surgery to remove the dead skin (known as debridement). I remembered advising her that the plastic doctor knows what is best and that it is better to get it done as soon as possible.
If the burn area doesn’t look good, if in doubt, it is best to seek a doctor. It is not advisable to wait and see how it turns out.

Wednesday, August 15, 2018

Children At The ICU

           When I was in the state of medical induced coma, my nightmares were terrible and vivid. In my nightmares, I was being constantly tortured by nurses and doctors. Some nightmares even repeated themselves, like a bad movie.

Pain, anxiety, frustration and all of the negative emotions could be felt in my nightmares. Feeling confused and frightened, there was a desperation in me as I didn’t know where I was and wanted to go home or at least inform my parents that I will not be home so soon.  There were also silhouettes of dark figures outside the room, looking in, as if waiting for something to happen.  

         After regaining consciousness around 2 and a half months from the date of my accident, I remembered hearing and seeing children playing outside of my room in the ICU. In the middle of the night, usually after 9.00pm to nearly midnight. There was a particular boy, whom I suspected to be the leader of the group, a Chinese boy wearing glasses, who looks to be around 7 to 8 years old.

Occasionally, this boy will be peering inside my room with his friends and say in a loud voice, “I don’t like it here, it is so quiet”.

            What nerve! such a pesky boy, I thought to myself. I couldn’t understand why the doctors and the nurses would allow those kids to play and make noise outside of my room.



         When my sister visited me in the ICU, a few times I have complaint to her about those kids playing in the middle of the night. 

          My sister looked puzzled and said, “There are no children here”.

          I insisted there were, and that they are making so much noise in the middle of the night.

         Calmly, my sister replied, “Don’t be bothered by them”.

         Months later, when I was transferred to the Burn Ward, I still recalled those children playing and questioned my sister again.

         She then told me, “Sis, that ward is for adults only. The ICU for children is not located at the same place. It is elsewhere”.
         
         I insisted and told her that this can’t be true as there were children playing there.

        In a firm voice, my sister said, “Sis, from my observation at the ICU, most of the patients in there are immobile and critical. Nearly half of the patients entering ICU will not make it out alive!”

Suddenly a realisation hit upon me, I pondered upon this. Who were those children? Why were they there? I was still not feeling satisfied with the answer that I got.

One day, I decided to ask one of the friendlier nurses who was attending to me during dressing. I narrated to her the story about those children that I saw in the ICU.

The nurse had a surprising look on her face, she paused for a while and said, “The adult ICU used to be the ICU for children. Yes, children were there a long time ago”.

Finally, I had my answer. I wasn’t crazy or hallucinating. The nurse then continued, “Eileyn, if you see the children again, if they invite you to play with them, tell them NO”.

Giving her an incredulous look, I replied, “Of course not! Who wants to play with them?”.   

I wasn’t really frightened, just puzzled with what I saw. I did know that I was given morphine during my medically induced coma, but that was before I was conscious of my surroundings.

Strange happenings didn’t only happen in the ICU, but also at the Burn Ward, from what I was told. One day, my sister insisted that she saw a particular nurse at the Burn Ward, but turns out that she was not on duty on that day. And she denied being around the hospital on that day too.  It seems this doopleganger appearance doesn’t happen only once but a few times, witnessed by others working there.

However, having shared the above story, I don’t think one should worry about ghostly appearances at the hospital. Whatever your religious background, just pray for protection and for the beings to finally find peace and stop lurking around at the hospital.




The Day I Came Out From The ICU

              I’ve stayed in the ICU for a long time that I was excited yet a bit worried about being transferred out from the ICU into the burn ward.

              There were a few nurses in my room that morning, preparing me for the move. A male nurse said, “Eileyn, you are the Assistant Village Chief of the ICU”. I was staring at him in bewilderment, puzzled by his statement. 

            “Huh? What are you talking about?” I asked in my barely audible voice, unsure whether I had misheard him earlier.

He then explained that the longest staying patient at the ICU was more than 4 months whereas I was there for the duration of nearly 4 months only.  Therefore, that makes me the 2nd longest staying patient there. I honestly didn’t know how to react to this. Part of me felt amused by his statement but another part of me had the revelation that I am lucky to be alive.  For me, being in 2nd place was already far too long to be in the ICU.

           Later, another familiar nurse came in to bid me goodbye. She informed me that during the first few weeks when I was at the ICU struggling between life and death, her mother was involved in an accident and was also admitted at the hospital. After seeing me struggling to live, the nurse told me that I had given her hope not to give up easily on life.

“Did your mum survived?”, I asked with my barely audible voice.

She said, “No. Unfortunately, she died not long after the accident”. 

I felt so sad for her. I couldn’t contain my emotions, and neither could she. We both held hands and cried.  

It was afternoon by the time preparation was done to shift me to the burn ward. As they wheeled me out with the bed from my room to the general area of the ICU, I randomly waved farewell to the nurses and doctors. I was quite surprised to see all the doctors and nurses saying their goodbyes in a happy manner and waving back. Some faces were familiar but there were also some unfamiliar faces to me.

I could remember the warm air as they push me out from the ICU. It felt really good as it has been really cold in the ICU. I enjoyed the short journey. Finally, I am out from that room.  

      
            My place at the burn ward seemed to be brighter with more sunlight. There was a window next to my bed. The nurse station was just on the right side of my bed. I thought to myself, ok, this doesn’t look too bad.  I will be OK here for a while.

Unbeknownst to me, the burn ward would be my home for another year. I would be the longest staying patient there.  In other words, The Village Chief of the burn ward.


ICU

           The first few memories that I had when I was conscious was that when I open my mouth, no voice came out. I couldn’t speak and my throat hurts. I could feel thick phlegm stuck at my throat, restricting my breathing. They had to use a suction machine and tubes to help suck out the phlegm from my throat through a hole that they puncture in the middle of my neck.  

            I could hardly move.  Muscles had wasted away due to lack of movement. They call it muscle atrophy.  I was bandaged from head to toe.  

         Once a while, a loud beeping sound could be heard from the left side of my room. I remembered my sister assuring me not to worry, and that the “beeping” means that the “medicine is finished”. Unbeknownst to me at that time, it was a multiple syringes pump dispenser for the different types of medications that were being administered to me through the right side of my neck. 
There was no emergency button at the ICU for the patient to press on, to buzz the nurses. One day, I had difficulty in breathing, was out of breath and no one was around. Feeling horrified with the realisation that I had survived the explosion, but would probably die of suffocation from my own phlegm, all I could do was to cough loudly to get the attention of the nurses. Even though I was struggling to breath, that was what I did. It felt like ages had passed before one of the nurses entered the room. That incident left a huge impact on me as I felt vulnerable and helpless. I was immobile and unable to communicate with anyone. It was indeed a frustrating time for me.   
Later, I learnt that I could only form a few words with my mouth to make the nurses understand what I wanted. The few words that I could use were “Cold”, “Hot” and “Water”. These few words were very important for me. 
I couldn’t drink water at that time. I was on drips. However, my mouth and throat were so dry that it felt so uncomfortable. It didn’t help that the air condition was so cold in the ICU.  The only thing that they could give me was some sort of thick liquid, just to wet my lips. I remember the first time they gave it to me, it felt so good. This liquid became my “Water” for a few weeks.
The person that gave me the most practical advice while at the ICU is my sister. I am lucky and grateful to have her. She would tell me to say and form only one or two words, as no one could understand what I was trying to say, and it end up frustrating me. As time goes by, my sister managed to read lip my words more than anyone else.
My sister informed me that I was lucky to be alive, that I sustained 80% burns. That 35% burns and above is considered critical. During the time in ICU, I had blood sepsis and nearly died a few times, after which my kidney failed and was on dialysis. Everyone was relieved that I managed to pull it through. The medical induced coma was around 2 and a half months.

Worried that I may be handicapped, I hesitatingly asked my sister, with my barely audible voice, “Did I lose any limb?”. 

“No, everything is intact”, my sister assured me. 

 “How about my face? I clearly remember the explosion happened in front of my face”, I asked, waiting to hear the bad news. 

 “Don’t worry sis, your face is fine, even though you sustained 80% burns to your body”, she assured me again.

Surprised by her answer, “Are you sure?” I questioned again. “Yes, don’t worry, your face is ok”, she had to reassure me.
I felt so grateful hearing this piece of information. For me, it is indeed unbelievable.
My house was another story, part of the wall collapsed due to the explosion, windows shattered, even the steel fence outside the house broke and fell on my car which was parked at the road side. The roof of my house had holes. Needless to say, the whole house had to be demolished and rebuilt again.  There were damages to my neighbours’ houses and even the windows of the house across the street were shattered.