Friday, September 28, 2018

Burn Survival

More than a week ago, there was another burn accident in Malaysia. This time, it was at a filming set. 31 people, mostly elderly got hurt when petrol vapourised and got on their clothes during filming of burning buildings. See stories: Filming goes awry  and  Double whammy for film crew

                                                 (photo source: The Star newspaper)
         What was shocking is that the incident still happened despite the presence of firemen on duty. I dread to think what might happened if they weren’t around to control the situation.
         It is indeed more difficult for the elderly to recover from a burn, especially if it is a large burn area. Age is one of the important factors that will be considered to determine whether a person will be able to survive the burn. 
         There is a method that is called the Baux score, whereby the sum of age in years and the percentage of body burn will be added to predict the percentage of mortality after severe burns. The Baux score was also modified to add inhalation injury which added the equivalent of 17 years (or 17% burn).
Per Cent Mortality = Age + Percent Burn + [17 x (Inhalation Injury, 1= yes, = no)]
        For example in my situation, 80% + 38 years = 118. Further, the doctors had to consider inhalation injuries as the gas explosion happened in front of my face. Meaning my chances of survival was really low.
        During the initial stages of my burn, I wasn't aware of the above calculation until one of the doctors casually mentioned that age and percentage of burns will be added up, to determine the mortality rate. He further mentioned that my case is one those cases where doctors still keep on trying even though the percentage of survival seems bleak. At that time, I knew that I was lucky to be alive, just that I didn’t realise the extent of it or how they calculated my chances of survival.
       When I was in coma at the ICU, a friend of mine actually took the initiative to ask 5 different doctors from different hospitals and practices and all of them did not expect me to make it out alive or gave me a less than 5% chance of survival. It seems that only a few people survived more than 80% burn in Malaysia.

        I am indeed very grateful to the doctors in the ICU and the plastic doctors from Penang General Hospital who did not give up on me, even though the chances of my survival were very bleak at that time. If they have not given their best, I would not have been alive today. For that, I am grateful.

       It is common to read or hear horror stories of those who are admitted in General Hospitals, where patients are neglected or not properly treated. Not many success stories are being told.  Therefore, I feel that my story needs to be told for a more balance view.  I have seen dedicated doctors and surgeons who are often exhausted, sleep deprived and going all out for the patient.  It is not easy being a doctor at General Hospitals with heavy workload and limited resources. They could just quit and work for private hospitals for less work and more pay. However, some still choose to continue to serve patients dedicatedly at General Hospitals and that is truly admirable.

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.