Thursday, November 13, 2008

A Cautionary Tale

Some of you have been asking for updates on Nadya, the four-month-old daughter of Peto, a reader of this blog. Nadya was in the hospital for heart surgery last Friday. Peto gave me the following update, which upset me very much. I think it's worth sharing with you because Peto's experience may one day save the life of somebody you love - somebody who can't speak for herself.

From Peto:

Saturday is a day I wish to forget; Nadya experienced a full left lung collapse because of negligence, complacency and bad management by the hospital staff.

Nadya was in the ICU, recovering from surgery. Thirty minutes after they removed the oxygen tube, I noticed her heart rate was going up drastically from 100 to 190, with the alarm sounding in a span of 15 minutes. I was in and out of the room informing the staff of the abnormal spike and Nadya's strange behaviour: hands flailing, legs kicking, hoarse crying and scared eyes.

I was told the increase in heartbeat was normal as she now required more effort to breathe on her own and she was probably in distress from crying, but somehow it didn't seem right to me as I had never seen those eyes before and there weren't any tears. Her voice was hoarse as if gasping for air.

As I coaxed her to calm down, I felt her head was feverish and immediately sensed that this wasn't right as her temperature had been 36.5 degrees just 30 minutes earlier. I quickly sounded the nurse again and she actually had to confirm the temperature with a thermometer under Nadya's arm pit, awaiting for it to beep, rather than a quick touch on the forehead. That waiting seemed endless and finally it beeped showing 38.2 degrees.

Luckily, a doctor happened to stroll by. I was then left standing outside as the staff spent 30 minutes in a panic, searching for a size 4 oxygen mask for Nadya. All I could see were nurses and doctors scrambling in and out the room, avoiding my eyes.

My heart sank when I saw a nurse doing a cross sign touching her forehead and shoulders as she came out. When I was allowed to go in, I broke down seeing Nadya's frail body attached to a huge mask trunk. They said there was high CO2 accumulation (up to 79?) with low oxygen. An x-ray showed full left lung collapse.

Thankfully, she is recovering well and under monitoring but I think I will be haunted by Nadya's scared eyes for a long time.

Advice from Peto:

I wish to say to all parents that you should never leave your children alone in the hospital no matter how safe you think they are. It's such an irony that all this could happen in an ICU ward and some of the explanations given by the doctors were very disturbing, such as:

- Nadya's ordeal is not uncommom after oxygen tube removal.
- We do have a mask on stand-by but unfortunately, it did not fit Nadya. And we used a hand pump while searching for the mask.
- It is understandable that as a parent you tend to take these things a bit harder although I think the situation is not as bad as you have perceived.
- Anyway, she is fine now!

All these remarks came after I told them that I hope they can learn from this experience as we could have lost an innocent life with this negligence.

- If it is not uncommon then shouldn't the tube removal be accompanied by close monitoring?
- Nadya was there for 2 days before the tube removal. The correct mask size should have been determined. What is the point of having a mask on stand-by if it doesn't fit the patient? FYI, Nadya has a perfectly normal head size for her age.
- Nadya was in distress during the 15-20 minutes it took to get the nurses' and doctor's attention, plus 30 minutes of mask-searching with the final diagnosis as lung collapse and CO2 built up due to lack of oxygen. And this doctor has the nerve to talk to me about parental over-reaction.
- The last comment is so irresponsibly shallow.

[Note from Shin: I don't like bashing doctors and nurses. I think they're human and they make mistakes like the rest of us. It's their unwillingness to admit to, apologize for, and learn from their mistakes that bothers me. A simple "sorry" would have made all the difference in the world to me in this situation.]

22 comments:

Java said...

Dear Shin,

Last night I prayed for you. I did not pray for you being cured, miracle and all, but for you to experience peace and joy for the remaining time you have left.

I can totally relate to your experience of having an illness that has no cure and doctors unable to provide straightforward answers.

I had 2 stillbirths lost at 35 weeks, first one in 1 June 2003 and second one on 22 Jan 2005.

You may ask why the second stillbirth was not prevented since there was a previous history? Reason being my first gynae diagnosed the first stillbirth as cord strangulation, thus my second gynae handled my second pregnancy as any normal pregnancy.

However when I lost my baby the second time, my gynae suspected something was very wrong and sent me for multiple blood tests and post autopsy on the baby. Turns out that I had a rare blood clotting disorder that clots the placenta at 35 weeks gestation, cutting of blood and oxygen supply to the foetus.

After my second stillbirth, I had little faith in doctors and went on the Internet to search for answers myself. I set up a Stillbirth Support Group on a motherhood forum as I was desperate to look for other ladies like myself who lost babies at a late stage of pregnancy.

The remedy for my blood disorder was to take blood thinners: aspirin and heparin shots throughout the pregnancy. However, I was too fearful to stretch my pregnancy beyond the 35th week mark, so I delivered my 3rd pregnancy at 34 weeks on 28 Dec 2005.

My son is the same age as Toby with similar toddler behaviour. At least Toby will sit by himself to eat his spaghetti. I have to strap Aaron to his high chair and he will play with his food after sometime.

Reading your blog helps me to treasure my loved ones more and not take my life for granted. I wish you well, happy belated birthday and I hope that you and your family will spend everyday living in peace, love and happiness.

Shin said...

Java,

Thank you, thank you, thank you for sharing your story on this blog.

I hope your experience will some day save a baby's life.

And good for you for using your experience to help other women by setting up your support group, instead of just keeping your knowledge to yourself. The world could use more people like you.

Tony said...

Peto,

Parental overeaction!! I'm fuming mad and I've never even met you. You must 1) immediately write down all details of the incident and keep a journal of all ongoing dialog with the hospital. 2) Write a letter to the head of nursing, head of the hospital, and usually they will have a head of risk managment at the hospital. 3) explain your main concerns (which to me sound like the lack of responsiveness and the lack of preparation, combined with the insulting personal comments). 4) explain that you want an explanation of what happaned and what they will do to make sure it will not happen again.

I imagine a letter to the Straits Times would gather much sympathy on your behalf, but I think focusing on an explanation and achievng some improvement in the hospital's process is more important. Save the letter to ST to use as a warning of what you may have to resort to if the hospital refuses to answer you.

Shin had a similary bad experience at Mt E. In that case, the head of the hospital, the head of nursing and the head of risk managment did follow up with an explanation, and explained why it will not happen again. You might want to highlight how it was done in Shin's case as an example of what you would like to achieve.

Good luck and my thoughts are with you.

Tony

Tony said...

This is my 2 cents on healthcare in Singapore.
Strengths:
1. Among the most modern in the world. Singapore has the most modern scan/radiation + other equipment. When we take some of Shin's scans to doctors in Australia, they admit they seem excited to be able to review them as they don't have access to such equipment.
2. Efficient system to adopt promising treatments. The US and other parts of the world have slow processes for allowing new treatments. Some the treatment that has been effective for Shin, would not have been widely available int he US at the time.
3. Some really good doctors who are well educated and on the cutting edge of new treatments.

Weaknesses:
1. Hospital nursing - In places like the US and Australia, nurses are the backbone of the hospital. They are very experienced and frequently know as much as the doctors. In Singapore, nurses tend to be hired from China or the Philippines at salaries that are very low. Nurses here are not very experienced and are insecure and overly afraid of offending doctors.
2. Many doctors tend to be too arrogant. They are put on too high a pedestal in Singapore. In the US nurses and patients will challenge them much more regularly. Challenging ideas is the best way for ideas to be refined and improved. That process does not happen here. In fact many doctors seem here seem agitated and offended if challenged.
3. Weak accountability. The US is probably over the top with medical malpractice lawsuits. But here it seems like the only recourse people have is a letter to the Straits Times. Doctors and Nurses don't seem to be as worried about being held accountable.

Shin and I are essentially "frequent flyer" users of the Singapore health care system, and we have compared it to advice from doctors/nurses in the US and Australia. So I think are views come with some legitimate experience.

Tony

Anonymous said...

I lost my dad 5 months ago due to a nurse's negligence. I 100% agree that we should not leave our loved ones alone in the hospital no matter how safe we think it is. It's not just applicable to children; it applies to adults, especially those who are in a coma and are at the mercy of the nurses and doctors! No words can describe my regret at leaving my dad for those few hours for the nurse to shift my dad to another ward.

I can empathize with Peto. It’s still not too late for Peto to learn from this experience though.

Anonymous said...

There is at present (quite recently) a group of unhappy parents talking about lodging a serious complaint to the Singapore Medical Association here in Singapore regarding the way some hospital doctors and staff are treating their newborns.

Peto might want to chat with these parents who are still conversing in this forum group (I hope Shin doesn't mind such external links).

HERE is the link.

Anonymous said...

Keep in mind that the Singapore Medical Association is made up of... doctors. Yes, the very same people you want to complain about.

I learned this when I wanted to lodge a complaint against a doctor some time back, only to find out that the very same doctor was the HEAD of the Singapore Medical Association.

Ronnie Ng said...

Shin/Tony,

I read somewhere that doctors among their own fraternity are discouraged from admitting an alleged mistake so readily & not to rush into a "confession" until there is an approval. This, I guess, comes from a Singaporean culture of fear. This culture of fear is a self-serving one & is prevalent not just in healthcare, but across other sectors like finance, civil service, etc.

Yes, I agree that the way to combat this is to instill more fear through collective complaints & threatening to write to The Straits Times.

Shin said...

Ronnie Ng.

I disagree about instilling fear. I don't think that's a very productive way to solve any problem.

Studies in the U.S. (land of malpractice litigation) have shown that patients do NOT sue doctors they like, no matter how legitimate the claim.

After the mistake that could have killed me, the hospital did exactly the OPPOSITE of what lawyers would advise: They admitted their mistake IN WRITING.

This was a huge risk, as I could have used that letter admitting fault against the hospital in court.

But I didn't. Why? The hospital's CEO, head nurse, and head of risk management made a personal visit to my house. They apologized for the mistake. The LISTENED to my concerns.

Most important of all, they gave me what I wanted: reassurance that this mistake could never happen again. They provided a detailed explanation of procedures they had changed within the system, to ensure that this could never happen to another patient in future.

I was extremely impressed at how the hospital handled the situation. As a result, the thought of taking legal action never crossed my mind.

Same for the doctor who initially misdiagnosed my breast cancer. She also apologized personally and admitted her mistake in writing. And she assured me she would keep my case in mind when faced with a similar situation with future patients. Again, I had no interest in pursuing legal action. I still have her as my doctor because she's earned my trust and my respect.

So you see, some basic human understanding and a willingness to forgive and learn from mistakes can go a long way.

Anonymous said...

Parental overreaction is a very common.

Singaporeans(in fact, most parents regardless of race or nationality) tend to overreact and jump at every small problem.

I have no doubt that in this case, you were right to raise the alarm. However, some of the issues that you mentioned like 'a touch of the hand to the forehead' and the 'right size mask not being available, thus requiring a bagging' are exactly what are the bane of medical staff. And what that the untrained person interprets as incompetence.

Many a parent have rushed their children to hospital talking about 'high fevers' and 'the body being hot to touch' but the end temperature shows something that is most certainly NOT a fever.

In addition, when a patient is breathless, or in acute distress, bagging IS actually a better option (as it is an active delivery system) then a passive delivery system (i.e. MASK)

There are many more things which I can expound about, but I will not do so.

Readers must understand that 'facts' are always embelished by 'feelings' and that this is only one side of the story. Ask the nurses, or the doctor, and they'll tell you something else. The truth is probably somewhere in between.

I feel sorry for you, and the stress and trauma that you're going through. And it doesn't help that there are certain complications that have occurred along this difficult journey that may have caused you stress that you could have done without, but doctors and nurses do not always have the answers, and they are human. To err is human.

I am most certain that the hospital staff are grateful that you were around your child during his stay in ICU, as the parent(s) are often enlisted to help out - by raising the alarm or performing simple tasks (as the child obviously prefers a familiar person performing uncomfortable tasks rather than an efficient and knowledgable person who is a stranger). However, it certainly does the medical team no good when parents are badgering the team for updates when an urgent resuscitation is being done. I am certain that the medical staff recognise the severity of the situation and will react accordingly.

At the end of the day, all I am seeking to address is that there must be some semblance of balance to any article. This being your blog, you are entitled to your opinion, as I am, but I am writing only to show that there perhaps could have been an element of over-reaction, albeit one that I am sure you may have thought at that time to be a perfectly normal reaction (as a concerned parent). And this point, I acknowledge.

I wish you and your child, the best of health, and a speedy recovery.

Shin said...

Anonymous,

Thanks for helping us consider the situation from the other side. You make an intelligent, well-articulated argument, which makes a lot of sense to me.

I can't speak for Peto, but for me, the problem was the lack of understanding by the staff after the crisis was over - no apologies or words of sympathy or consolation.

From my own experiences giving birth to two babies and going through three years of cancer treatment in Singapore (with some comparisons to medical visits to the U.S. and Australia), I'd have to agree with Peto.

Doctors and nurses in Singapore generally do not listen or communicate very well.

Jane said...

I am a nurse. I would like to say sorry to Peto. I will pray for your daughter's recovery and support you in bringing up this issue to the hospital risk management.

I agree with some points of all your (Tony and other readers') comments.

1) The doctors here are arrogant.

2) Some nurses don't dare to question doctors' orders.

3) Some of them try to avoid the patient's family when there is something wrong.

However, that is not all.

1) Those nurses hired from China or the Philippines are degree holders. The local nurses only have diplomas. Previously, most of the people who chose nursing did so because thier "O" level results were too low to enter other courses, and nursing was an iron bowl. It is only recently that NUS opened a nursing degree course, and there are some part-time nursing degrees by Australian universities, and special training in Advanced Diploma. However, the hospitals don't treat nurses well, so most of the good, educated nurses leave for other countries, such as U.S., U.K., Australia.

2) The healthcare system is different here from the USA and Australia. In Singapore, nurses don't have much power. Even if they don't agree with the doctor's orders, they still need to follow the doctor's instructions.

3) Their workload is double or triple that of nurses overseas. That means there is high risk of breach of duty of care, because they can't cover all care aspects.

4) In fact, nursing care in government hospitals is much better than in private hospitals (My own experience).

Please give some time. The Ministry of Health and hospitals are trying to change the current situation.

May God bless you all.

Jane

Shin said...

Jane,

Thanks for your comment. I was hoping for a healthcare professional to tell the other side of the story. It leads to better understanding on both sides.

We can learn from this back-and-forth. Something good will come out of this.

Cheryl said...

Hello Shin : )

Happy belated birthday! I'm Cheryl here. I'm seventeen. I remembered seeing you early this year at my aunt's place & that was during Chinese New Year. Two weeks ago I saw you at the poolside. And the next thing, you were on TV. You're really inspirational. Shin, you're in our thoughts & prayers.

Warmest regards .

Shin said...

Cheryl,

I'm embarrassed to ask, but I'm not sure who you are. Who's your aunt?

Tony said...

Jane,

Thanks for your insights re nursing/med care in Singapore.

Also, I didn't really mean to be complaining about nurses themselves, but rather that the profession is not respected enough in Singapore and that they really make the difference in running a hospital well. In a typical hospital stay a patient will see their doctor for maybe an hour a day (if that), but will being dealing with their nurses 24 hours a day. They make all the difference between making hospital stay good or bad.

When we had our meeting with the CEO of Mt Elizabeth, I made exactly that point. They brought the nurse who made the error to apologize in person to us. But I told them that is not what I was concerned about. We explained the big difference in the experience and authority that nurses have here vs Australia/US and the massive subservience to doctors here.

I have a lot of stories that I could use to illustrate. One was when Shin was in a lot of pain during a hospital stay. I went to the nursing station and asked for something for her. After a while i went back out and reminded them. They said they were waiting for the doctor's approval and couldn't reach her. I asked can't they just give her a panadol? They looked horrified and said no. So I went to guardian and bought it myself. 2 hours later they came and offered a panadol.

Another time after Shin's seizures our friend Shelly was looking after Shin at night. When Shin was finally able to get some much needed sleep, a nurse came in loudly ripping open a blood pressure reader. Shelly jumped up and said Shin had only just gotten to sleep, and does she have to take the reading at that moment. The nurse walked away in a huff and said "ok, you don't want it". Shelly ran after her and said, she doesn't know if it is critical or not, it just that Shin had been trying to sleep for hours and Shelly jsut wanted to know does it rally have to be done right then. The nurse went and called the doctor again and came back and said it was nessisary to monitor Shin post seizure period.

I guess my point is, Singapore nurses need to be given more authority to deal with their patients. they need to know why they are taking blood pressure or other such things and they need to understand a patients condition well enough to know if they can give them panadol.

That being said, Shin has also had some very good nice nurses that treated her well and looked after her caringly. Just without much authority to do anything.

Tony

Anonymous said...

We often say doctors are also humans and hence being imperfect and making mistakes are unavoidable. In my case, I'm still very angry with the doctors and health care professionals who misdiagnosed my dad's condition and caused his death indirectly.

My dad had colorectal cancer 4-5 years ago. His carrier cells recurred in his liver and lungs 1-2 years after he did his chemotherapy treatments. But he did not go through operation again as the tumour was too near his liver's hepatic portal vein. But he was healthy, he still could eat well,and could even go gym and jog with me and even work. I'm a student in medical-research related studies as I hope to be able to cure him one day but it all was too late now.

My world started falling apart at that time when my dad started having persistent backaches. He thought it was just a normal sprain and kept going to all those Chinese sinsehs. I knew something is wrong - at that time, I sensed that his cancer cells could have migrated to his spinal cord region. I told him what I thought could be happening and that he should seek immediate treatment from the oncologist... after much persuasion he agreed. My dad agreed to seek treatment but it was the doctors who have failed him.

I can still remember the A&E doctor who diagnosed my dad one night when he was in chronic pain (at that time he did not know that the tumour had grown in his spine. He was in too much pain and hence finally listened to my advice to go to the hospital). He just looked at my dad's back, touched a bit and concluded it's a sprain and hence just intended to issue him a prescription for muscle sprains. Even though I was not medically trained to be a doctor, i could sense that this was not a simple "sprain". I told the doctor to at least give him an x-ray to find out what's wrong since we have already brought my dad to the hospital and it's not like we couldn't afford it. He finally agreed... my dad's x-ray showed that there was a fracture in one of his spinal column and from the picture, i could see a protruding swollen tissue near the column that had the fracture. He postulated that might be a slipped disc. A slipped disc? If I did not insist on an X-ray, could he had even notice there's something wrong with my dad's spine? He was even shocked at how much I know about medical issues and even asked what was 1 studying. Aren't he ashamed that his 5 years or medical school studies and 3 years of housemanship is a waste?


Fine, so my dad was referred to a bone specialist who also assumed it was a slipped disc even though I told him very clearly that my dad had a history of untreated cancer and it could be tumour in his spinal cord. Yes, he ordered for an MRI scan. But the scan was a mistake -they could not interpret that was a tumour and assumed it was just a slipped disc!
2 weeks later, my dad's legs grew numb. He was in chronic pain even though he went For his physiotherapy treatments as instructed. His legs become so weak that he couldn't walk. I admitted him to another hospital and they did a MRI on him - it was a huge tumour compressing his spinal cord! I testified both MRI scans - I had the hard copy of the first scan that they said they couldn't see any abnormal growth and my dad's doctor showed and explained to me this scan that confirmed the tumour growth as I was able to understand anatomy and biological topics. when I did a comparison is the scans,they looked the same, except with greater compression on the cord! I was so angry that I wrote a complaint letter to the hospital that misdiagnosed my dad. But their reply was the MRI scan report said it wasn't an abnormal growth. Is that a responsible answer?

My dad underwent surgery to remove the tumour and part of his spine but with metal support implant. He was still able to walk and feel the floor at that time and even went through radiotherapy after the operation. But 2 weeks later, his legs became numb again. We admitted him to hospital again and MRI scan was done again - the tumour had grown three again. The only option left were to operate on my dad again,which my dad refused because the tumour might grow back again after operating and that time my dad had lost alot of weight and was too weak to undergo any more operation.

He became paralysed. I couldn't bear to let him know that he had indeed became paralysed. My heart still hurts whenever i thought of how he went from being such a healthy dad who jog and joke with me to became paralysed and cried all day. He would often ask me " what happened to my legs? They are so numb. I can't feel anything." "I think it has too much water retention. Don't worry, let me massage for you." I would lied.

Peto said...

To Anonymous who said,-
"Parental overreaction is very common."

As a father of two children, and a son living with two chronically ill parents (dad – stroke, mum – dialysis), I assure you my untrained hands are competent enough to know what’s hot and what’s not.

I'm not saying that the nurse should use her hand and not the thermometer. But we were in a situation where a supposedly sedated baby was flailing in distress for over 15 minutes, accompanied by a continuous alarm indicating an abnormal spike in the heart rate from 100 to 190 within minutes.

Weren't any of these 3 distress signals enough to raise a concern? Or is there an ICU rule that only a confirmed fever is required to get the doctor’s attention?

To me, waiting for another three or more minutes for the thermometer to beep just to confirm a fever of 38.2 degrees under such a situation was ridiculous, especially by the same nurse who had just taken the temperature of 36.5 degree thirty minutes earlier.

Would you like to imagine the scenario of my absence where the three distress signals were considered normal and expected by both doctor and nurse? Or me trusting their judgement which I regretted doing by coaxing Nadya not to cry for the whole fifteen minutes until the fever touch? What do you think would have been the chances of Nadya smiling again?

For your info, Hazel and I were advised to rest at home during the first night as Nadya would remain sedated. I decided to stay and told Hazel to rest at home with our elder daughter. While dozing off at around 4.30 a.m., something made me open my eyes; I’m not sure what. I was shocked to see the front end of the bed where Nadya was lying elevating up to an angle close to 45 degrees, and I shouted.

Pops up a nurse at the rear end of the bed holding a bed remote control and luckily she stops in time. She apologised and explained she was trying to raise the rear end of the bed to free the trapped drainage tube from Nadya's operated chest. I did not vent any anger at the nurse as she was of great help and I'm sure she meant no ill. I even agreed that the controller picture buttons are rather misleading and suggested that it should be placed under the bed compartment rather than hanging facing out of the bed side frame where it may be accidentally activated by visitors.

This incident alerted me that I had to stay with Nadya at all times, no matter what. The "what if" scenarios were unthinkable.

Thank you for your well-wishes, and I agree with you that readers should not just listen to one side of the story.

So here are some of the "gestures" from the other side during and after the ordeal:

- "Are you ok? I assure you they will be scolded."
(Said by a junior doctor who, ironically, told me that the spike in heartbeat was normal even though the alarm was activating throughout.)

- "No wonder I saw sister (head nurse) was scolding all of them for failing to locate the mask."
(A nurse who had missed all the action.)

- "Please be assured that while searching for the mask, I am
administerting oxygen through this hand bagging."
(The senior doctor.)

The problem was that this hand bagging apparatus was not ready for use. I watched the nurse use scissors to cut the yellow mouth piece for fitting after she could not find the mask.

Thank you for your insight on the effectiveness of Hand Bagging to air pressure mask but either way you are missing the point. I do not give a "poos" about the effectiveness, I am just "Pees" that these alternatives should have been readily available, especially in an ICU pediatric ward which preaches "this ordeal is not uncommon for oxy-tube removal."

The fact is, Nadya has suffered a full left lung collapse due to this negligence. She is supposed to be in a well-equipped environment to help her recover from a heart surgery, which is supposed to prevent her lung from failure. How ironic?

Talking about ironic...

I had told Hazel the night before the ordeal that we should consider ourselves lucky and we should try not to bother the nurses and doctors too much as there are many other seriously ill babies who require more attention than Nadya. We should not escalate our joy when Nadya wakes up, out of respect to some other worried parents.

Babies such as…

Little Jillian, only two years old who is in a coma for a failed kidney, which is her only kidney.

Baby Samuel, four months old, with an abnormally oversized heart and liver and requires life supporting m/cs causing $2,000 per day. His stay for three months already works out to be $200,000 so far. And imagine he still has to fight for another 8 months.

Both parents of these two babies are very extraordinary people just like dear SHIN, and I am very honored to share a nod of respect and smile when our paths cross. I must acknowledge that they are heroes in their own special ways and the only difference between SHIN and them is they don't write a blog.

The day when the thoughts of losing Nadya and witnessing the chaotic commotion alone in silence brought me to curse my "coolness". If only I had been more persistent with my parental instinct which in another’s words was "parental overreaction", maybe Nadya would not have suffered as much?

So next time if you should visit a hospital, check out these "Parental Overreaction" parents and you will be surprised. They will get all the attention required while you smirk at their foolish behaviour as they winked past you in the queue. I'm one of the latter who once waited for hours until I was the last one remaining and all I got from the nurse was, "Oops! I think we have missed your place in the queue."

Sorry, I do not think your argument is any near intelligent or well-articulated as you were not there to judge the situation. You seem to mistake me for some wayang character. I did not badger for updates nor was I near my daughter swearing at the doctors and nurses. Instead, I just stood in silence, hopelessly against the wall feeling guilty for not reacting as an "overreacting parent" would do. To me then was "cowardice".

As a regular visitor to many hospitals due to my family's outstanding medical record, I, too, have many incidents recount as well which would send shock waves to our medical system. Unfortunately, at the end of the day, this is still my problem.

But maybe to share a few personal incidents:

- After Nadya's discharge yesterday, we had to take her back to the ward around midnight in the rain because her supposedly waterproof taping leaked. I had told the nurse earlier that she should not have stretched the tape while placing it over the crease around the groin as it will not stick onto the crease. Instead, she ran it over with her finger and claimed it will stick permanently. We went to A & E and was told we need to pay $90 for re-dressing even though the discharge was nine hours earlier. We went back up to the ward and got it done free.

- While we were waiting for the discharge, the teen in the bed across from Nadya who was operated on a few days earlier to correct his curvature of the spine was transported to the x-ray room in the operating bed trolley ordered by the doctor as he was still weak, in pain, and could not walk. Later, his aunty was making a scene, complaining because the boy was told to walk back to the ward without a trolley or wheelchair.

- This is my all time favourite…
My mum, who broke her femur bone, was sent for a month of physiotherapy which later, I learned required her to walk up a 3-step stair. It was later found that she was mistakenly placed through the therapy for operated plate implant patient where her broken femur was not operated on because she was not fit for an operation.

I could go on but I do not intend to check into any of them yet.

What can I say to these professionals but I suppose we should be compassionate because they are humans so they are allowed to err? This is really scary!
---

Vinz said...

It's my first time reading this blog... and my my... I totally agree that some doctors in Singapore are pretty arrogant and also the point that nurses in Singapore don't seem to be well trained enough to handle situations on their own.

Perhaps it's the hierarchical structure of roles, or even the possibility of red tape that prohibits nurses from stepping in when doctors are not available.

Peto said...

Don't mean to turn your blog into a hospital complaint blog but I would like you to know that I have decided to heed Tony's advice and lodge a complaint to the hospital tomorrow.

Just came back from A&E again due to an infected wound. This was the third time we had to get the wound cleaned and re-taped since Friday's discharge. Friday night, A&E followed by the ward due to poor dressing (6 hours after discharge), Saturday morning went to the Polyclinic to have the ineffective dressing re-taped again which fell off again, and tonight A&E due to infected wound.

The crazy thing is, the A&E doctor suggested removing the stitches to avoid a flare-up but needed the surgeon's agreement first. Unfortunately, the surgeon involved was in the operating room so could not assess Nadya's wound. We were then given two choices, either consider admission and wait for the surgeon's assessment or come back the next morning after cleaning up the wound. We chose the latter as we did not wish to have any more surprises from the hospital.

We ended up paying another $90 for A&E + $66 for an infection test and the last straw was another $13 for a bottle of antibiotics. I thought medication was supposed to be included in the $90 A&E charge? I inquired. Oh no sir! This one was not included because this was a non-standard drug! Wonder how much they're going to charge us for tomorrow's appointment. All because of a wound which could have been avoided (long story), bad stitching which I have highlighted about ICU (longer story) and ineffective dressing which I have also highlighted during discharge (what else but another long story).

Poor Nadya has to put up with all the pain even after being discharged.

JX said...

Hi.

I'm a staff nurse working in one of the cancer centres in Singapore.

I was reading through all the comments and I just feel so sad.

It seems almost everyone here has a lot of complaints about Singapore's healthcare system, mainly with professionalism & communication.

I do agree that there is still a lot of room for improvement in these areas but can I just highlight one very important point? A lot of us join this profession to help people, not to harm or kill them.

I believe that there are black sheep in every profession, but we healthcare workers are judged more harshly because we are dealing with life & death situations. Can anyone imagine how stressful that can be?

I start work everyday bearing that in my mind and try my utmost to help the patients I nurse, and I'm fortunate to be working in a department with supportive doctors.

Anyway, it's with feedback and continuous improvement that we can become better. I'm just hoping that people don't jump to a conclusion of negligence so easily.

With that I would like to say there are also a lot of unreasonable patients out there who make ridiculous demands and treat the nurses like maids. I'm sad to say many of these people are Singaporean. And when we meet such patients, what do we do?

Most of us nurses, at least myself, understand that patients don't mean it. They are sick; it is only natural that they are irritable and demanding. But then again, I'm only human. Sometime the abuse from patients & their families can be so bad that I wonder how I manage to continue working. But I do, in fact, love my job and really appreciate that I’m able to help cancer patients because they teach me so much about life.

The fact is that in Singapore, there are just not enough locals who want to be nurses. That's the reason why there are so many foreign nurses and I salute these foreign nurses who leave their country and come here to help us.

I guess many locals still think that nursing is a "dirty job"; it’s just about wiping patients' asses. That is so not true.

In the short time that I've been working (8 years) I have started to see improvements in the image of nursing and I'm hopeful that there is more to come.

Meanwhile, my colleagues & I will continue to provide good care to patients.

P.S. To Shin, I greatly admire your courage and strength in dealing with illness. You and many of my patients have taught me about facing adversity positively and I greatly appreciate that.

JX

Shin said...

To those who think arrogant, abusive doctors are a problem limited to Singapore... I just found this article in The New York Times.