Beneath Those Clothes

Written By Alvin Tng, Year Two Internal Medicine Resident, SingHealth Residency, Singapore

*All names have been changed to protect the privacy of the patient and family.

150415I first met Madam Ng*, who was in her forties, during my second month in Oncology in NCCS. It was my first day in a new team and Madam Ng was just another patient hoping to be discharged ASAP. Throughout the next two months, I would see her two to three more times as she came in and out of hospital.

She was very spunky and combative, always asking why she needed this procedure, that scan or when she could go home. But with each episode her energy took a nosedive in comparison to her rising Bilirubin levels. She became quieter, more reticent. She never lost her spunk, though. After asking her umpteen times if she had any pain, she would snap back with a feisty “like that lah!”

I eventually lost track of her as my posting ended and I moved on to other rotations.

Fate brought us back together three months later when I was assigned a review in Palliative Medicine. There she was, sitting on her hospital bed with a frown like Grumpy Cat’s. The clothes hung off her even thinner frame, which was paired with her biliary drain bag that had become her new companion.

Hi, Mdm Ng! Remember me?” I burst out, perhaps a little too chirpily.

Silence.

Aiyah, of course lah. Why you back here again?” She grunted, as I sat down to listen to her complaints.

The next day, Madam Ng was down in Radiology for a scan but I found her husband by her bed. Truly, they were a charming young couple but Madam Ng’s cancer had robbed her of her health and bestowed upon Mr Ng a greying hairline and extra worry lines on his forehead. I stopped and asked how he was. He looked mildly surprised. It was clear he was more used to talking about his wife than himself.

“You know, she used to dance?” He suddenly mentioned, a hint of a smile tugging at his lips. No, I replied, genuinely surprised.

Turned out she loved dancing in her free time, and was upset that her disease had robbed her of her health and everything she treasured in life. The conversation lapsed into a silence, as each of us, lost in our own thoughts, shaped our own mental images of Mdm Ng.

As healthcare professionals, we often fall into the monotony of the daily grind. Our patients get admitted, we write out a problem list, order bloods, order more antibiotics, order even more scans and then send them home.

More often than not, we forget that behind that blue or pink hospital baju is someone’s parent, sibling, child and a vibrant personality. We forget – or we actively choose to forget – that the new patient sitting in front of us is actually an active member of society before he came into hospital.

Proponents of holistic patient care would argue that we should actively try to know our patients beyond their medical conditions. Knowing their social background has many benefits – assessment of available home support helps in early discharge planning; connecting with  patients’ family improves family participation in patient care and makes discussion of sensitive topics such as end-of-life issues much easier; connecting with the patient also encourages compliance to medications and follow-ups.

On the other hand, naysayers would argue that we need to maintain a distance from being too involved with our patients . Not to mention with the huge patient load on call and in the clinics, it is near impossible to parcel out that extra five to ten minutes to properly sit down and get to know our patient better.

The answer is probably somewhere in the middle.

We need to address both the medical and social issues at heart. Getting to know the patient beyond his medical condition is just one step in the direction of holistic patient care. I think I can safely say that most of us healthcare professionals would like to engage our patients and know them better beyond their medical conditions.

Small steps in this direction would include improving the doctor-patient consult time. This is a fine balance between clinic resources, manpower, costs and patient load – an equation perhaps best left to the administrators.

For us on our part, the next time we see a new patient during our night call or clinic, or when we see our regular long stayer patient in the ward, remember and try to see beneath those hospital clothes – for in there, lies a unique individual..

Coming back to Madam Ng, a month after our last encounter, I chanced upon her obituary in the Straits Times. She had a Christian name, Maureen. And she looked very happy in her picture.

She had finally returned home. To a happier and pain-free place where she now belonged.

From Tomorrow’s Medicine