Lady from Medan: It all started with a pulmonary embolism

It all started with a pulmonary embolism.

It was then I realised I was but only a doctor.

 Today, this small lady from Medan who was accompanied by her nephew, sat on the sofa adjacent to each other. I sat on the coffee table. She was dabbing her eyes minutes before this conversation started.

"Loh kun, tolong lah, qiu qiu ni..."


She held my forearm and had this hollow, lost look, her moist eyes pleading; my heart really sank because I knew I could not deliver; as there was only so much a junior doctor like myself could do.


She was newly diagnosed with squamous cell carcinoma of the tongue, admitted for further intervention; however the discovery of a history of pulmonary embolism and right heart failure rendered her unfit for surgical intervention. Therefore she was discharged ASAP, as Boss fully knows that an additional day of admission would incur another day of expenses for this patient who left home with all she had with the hope of a cure, however corny that may sound.

Further assessment of her fitness for surgery would include a 2D-echocardiogram; however the earliest appointment date was Jan 2011. (On hindsight, the gruesome picture painted by my Registrar was starkly horrid, but probably true- "2DE in Jan 2011? By the time we get to operate on her, it will not be an operation already, it will be a post-mortem! It's cancer we are talking about you know?")

In view of the very warranted need for an urgent appointment, I spent the next 2 hours calling the cardiologists, then proceeded to call the Echo lab officers - and almost got into an argument with them. Trying hard to suppress my exasperation, stern but not yet shouting, I had to convey to them I needed most desperately an estimated appointment time for my patient - can I get it within days? Months? Weeks? It would make so much difference to the patient because if she cannot afford to wait, say 2 weeks for an appointment, at least she can return to Medan to avoid incurring cost while lodging in Singapore. However I was replied with a curt and cold "I don't know, just fax over. I cannot tell when", a line that was already repeated to me for the umpteeth time.


I was angry, tired and felt most dejected...

It was that time I felt most trapped by the system which was supposed to help me. I felt that the system was but a structure, and we are humans who are capable of analysis, discernment and most of all, the ability to feel - yet I was appalled that the system takes precedence of its more superior and complex creator, the human being.

I was angry for many hours, till a few moments ago, then I realised I could blame no one; in the complexities of our systems and the myriad of protocols we create, we effectively remove the humane bit out of the system, and create micro-roles for these people who work for it.

The cardiologist's role is but to assess the 2DE and later, the patient;

The lab officer's role is but to schedule the 2DE appointments she receives through the fax.

The ward clerk's role is to fax the fax over to the lab,

The surgeon's role is to dissect the diseased organ.

And of course, the house officer coordinates all of the above, so the last one can be done.



It was hard to take out that image from my mind; that lady from Medan, sitting on the sofa with her worn-out luggage bags. It was 4pm, and reruns were showing on TV in the discharge lounge. The happy songs on TV ironically reflect not her thoughts; as her original plan to come in for surgery, then leave for Medan as soon as the deed is done. Now she has paid SGD6000+ deposit, with no guarantee of surgery of yet, and no 2DE appointment in sight as we speak. No relatives in Singapore, spoke little Mandarin, She pulls the sleeves of her faded denim jacket down, at ill ease from the cold.  How, doctor, how are things, she asked in Hokkien. I said do not cry, we will help you. We are doing our best. My heart and morale took a dip when I finished saying that line.