First Doctor Appointment 2019

His frustrated eyes into mine. I could sense his impatience of wanting to return home. His body language revealed to me he did not want to be here. Patrick was sitting upright on the metal chair while looking up to me. 

I touched the back of his palm where the earlier blood extraction was taken place. Gently I rubbed that area as I tried to make him understand.

"Remember here? The doctor take your blood? Blood removed from your body."

I rubbed the back of his palm a few times. Then made a gesture of my hand moving beyond his hand.

"Blood take out for doctor to read. Doctor to read whether Patrick's body is strong or weak. Cannot leave the hospital yet. See doctor first. I am sorry, Patrick."

He gave a frustrated sigh. 

Before our conversation, we waited for a few hours for his turn to do his blood test. This time more blood to be extracted in order to have a thorough reading on the state of his liver functioning.

By the time it was Patrick's turn, he was already sleeping in his stroller. Unfortunately, his peaceful sleep was disturbed to do the blood test. He was crying and fearful throughout the process. I kept assuring him it would soon be over. 

Blood test needed to be done in order to know the next step of Patrick's fate.

Blood extraction was done on Patrick. It can be a scary experience
because adults had to hold him down to stop him from squirming.
We had our lunch, and it was another hour plus before it was Patrick's turn to see the doctor. 

Patrick clung closely to my body when we entered the clinic. He was suspicious of the doctor although she smiled gently to us.

"The bilirubin is 215. It went down from the previous 275." 

That last jaundice reading was taken in November 2018.

I felt happy until she continued further that made me worried.

This closely represented how I looked and felt when the doctor
informed me INR unusually high.
"However, the INR showed 5.7. When was the last time he did INR?"

INR (International Normalised Ratio) is a method to check whether the patient have a blood clotting problem. If INR too high, there is a risk of bleeding because the blood clots formed too slowly. That means whenever there is an open wound, it take a longer time to stop the bleeding compared to a normal person whose INR are of normal range. 

I was like...what?? INR results showed 5.7? Isn't that high?? I remembered last year we did the INR test during middle of the year of 2018, it was on borderline 1.5. Prof Ng immediately suggested placing Patrick on Vitamin K in order to check whether it was signs of liver damage or deficiency of Vitamin K. And if it is latter, the taking of Vitamin K would return the INR results back to normal. If that did not help that means the liver has deteriorated further.

"Is Patrick having fever, flu and cough now?"

"No, he is not. Earlier he did. Last year. A short fever. Only two days. He had flu last year, November or December I think. Lasted almost two weeks. He's ok now."

I replied, trying to remember the best I can.

"Any bleeding?"

Both myself and my husband reflected.

"He did have the occasional bleeding in his stools. His nostrils too. But that could be the nasogastric tube rubbed against his nostril. Last year he vomited. Got blood. But happened once."

The doctor inquired, "Was it a lot?"

"It was not. Only a small amount. I even highlighted to Prof Ng. He advised me to observe. No further episodes of blood in vomit. It was suggested that maybe when he vomited, he hurt his throat. That's why the blood."

The doctor's eyebrows deep in tension. 

"The INR results may be indicative of liver damage. I need to call Prof Ng. Please wait."

Then she left the room.

My husband did notice Patrick's activeness level for the past few weeks have not been his usual. He appeared wanting us to carry him more. He did not appear wanting to crawl as much as before. Usually it is my husband who encouraged him to be more physically active. To me, I assumed maybe he wants us to carry him around more.

When Prof Ng came in with some doctors, he checked on Patrick's blood results. He shared his concern of the high level of INR. The external bleeding was not a concern as it can be managed. Only concern when there are any internal bleeding such as the brain. 

The other tests on Patrick's liver functioning appeared to be higher than his usual results. When we inquired on what basis Prof Ng would decide that it is time for a liver transplant. He said he relied on bilirubin reading and the INR to reach to that conclusion. For now, need to test out whether Patrick having vitamin K deficiency or his liver damage has started. 

Prof Ng insisted Patrick must have a vitamin K injection before he leaves the clinic. After discussion, Vitamin K is prescribed for Patrick to take daily in addition to his medication. The next doctor's appointment would be set in two months' time.

However, my husband felt that his appointment should be earlier. He confirmed with Prof Ng that it takes one week to know whether Vitamin K have an impact on his INR reading. So the appointment is set for next week. My husband felt we should not delay if Patrick starting to have signs of liver damage. If it is so, not to waste time and go straight into planning for a liver transplant. We saw too often how suffering the baby or toddler would undergo when the liver deteriorate further. And sometimes it can deteriorate so fast. We want to catch the extra time before THAT can happen. 

Patrick, we will make the best decision for you. We will not hesitate. We will not waste time. We shall save your life. God, please give us strength, courage, clarity of mind, calming heart and determination to oversee this challenge. 

I will persevere! I will prevail! For Patrick, I shall!


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