Partners in the Process
Tey Min Li &
Teri Danielle Yeoh You Ying
Medical Students Get a Firsthand Take on the Journey to Recovery that Patients Face Through the Longitudinal Patient Experience
He has walked through fire. Literally.
G, a 27 year old gentleman, sustained a devastating 70 percent burns injury from a workplace accident. Through the Longitudinal Patient Experience programme, we have been privileged to journey with Mr G on his path to recovery.
We are introduced to G in the SGH Burns Ward. Sitting up on a chair, he is having his lunch as his mother and aunt keep him company. As second year medical students, he is the first burns patient we have encountered. He shares how only his feet, garbed in work boots, had been largely spared from the fire.
In our subsequent visits, we gradually get to know G better.
G details the many months he was in hospital – his fading consciousness in the HDU, his inability to communicate while on the ventilator. The numerous operations and skin grafts. It has been an arduous process, for both him and his family, who have played no small part in G’s road to recovery. In spite of the long road ahead, G retains a charming sense of humour in relation to his condition. With a small laugh, he cheerfully comments how surprised he was, after waking up from yet another reconstructive facial operation, that he now has double eyelids courtesy of the plastic surgeon.
Despite the devastating effects of the accident, G has continued to take things positively, and his sheer fortitude and optimism has been most humbling and inspiring for us. He is keen on contributing to activities in the Burns Support Group – from providing guidance to recent burns victims, to speaking with conviction about the need for more awareness regarding skin donation in Singapore.
What we found particularly hard-hitting was how G’s position was so relatable to us. Getting to know G, he shared with us anecdotes of his time in university, his time spent abroad on student exchanges, and even his work-study experience in the United States. He also shares with us how he took the photograph that hangs behind him, adorning the living room wall – a beautiful panorama from a Greek island. The accident has put on hold, but in no way derailed G’s travel plans. G speaks animatedly of looking forward to a short trip in the future, when he has regained more of his strength. He repeatedly urges us to explore the world and seize opportunities to go overseas where possible.
Yet, in spite of all that we’ve taken away from our conversations and that little friendship we’ve developed with G, we sometimes still struggle to understand how we could best communicate with G – there were times we simply ran out of conversation topics, or fell short in terms of knowing how to demonstrate our empathy.
There were times we didn’t quite know what we should be doing to make G feel most comfortable, and there were occasions where we felt like we were really taking away more from our conversations with him than he was from them.
Yet, this is perhaps what the art of medicine is all about, and we are really just students who are still trying to learn and grow by the day. Perhaps one of the greatest takeaways we’ve had from the Programme thus far, too, is realising how life is about many journeys coming together. We have just embarked on our journey to learn to be good doctors in future. G, too, is on a long journey that is hopefully headed towards gradual recovery and healing.
We’ve also come to see first-hand through this little friendship we’ve built that sometimes, medicine is not just about delivering quick cures or fast solutions. For all the progress modern medicine has come to make in terms of being able to eradicate diseases and conditions, it is important for us to realise that sometimes, recovery is not always swift. Sometimes, recovery can be a very long journey we have to struggle to make.
The road is never easy, and we may sometimes encounter road blocks, false starts and stops, detours, and potholes along the way. And sometimes, when we think there’s nothing else we can prescribe, it’s often an extra dose of compassion and empathy that counts.
The Stroke Patient – Weakened in Body, Undiminished in Spirit
Lai Kah Ho and Lee Xing Ni Janice
Forlorn, debilitated and dependent – these are common and stereotypical views of stroke patients. Participating in the Longitudinal Patient Experience programme has helped to change those views for my partner and me. We met our first patient, Mr Lim, at Ang Mo Kio – Thye Hua Kwan Hospital, along with our mentor Dr Loh Yong Joo. As we followed Mr Lim on his journey to recovery, we witnessed first-hand the joys and struggles that he as well as his caregivers underwent throughout a year.
Prior to the stroke episode, Mr Lim was a chef and the sole breadwinner for the family. Post-stroke, he was declared unfit for work and had to accept the reality that he would no longer be able to continue with his role as provider.
Throughout our time with Mr Lim and his wife, we saw how he continued to strive, wanting to make more progress in recovery. Although he was limited by his physical disability, he makes it up with his mental and emotional strength and tries his best to regain his daily functions. He engages in exercises recommended by his physiotherapists and occupational therapists and does his daily walks along his HDB corridor.
He also puts in great effort to communicate with us despite having difficulty finding the words to express himself. When Dr Loh told Mr and Mrs Lim that his recovery would plateau eventually, he was not fazed by the news; instead, he remained positive about recuperation.
We also gained a clearer perspective of outpatient care for patients with chronic physical disabilities, their daily struggles and the treatment dilemmas they faced. Botox injections were recommended to Mr Lim for temporary relief of muscle spasms, which could allow him to exercise and possibly make better progress. However, the effects wore off after three months and both he and his spouse felt that his condition had deteriorated slightly post-treatment. They were then faced with the dilemma of paying for another dose of Botox, of which the effects are uncertain, or to decline Botox treatment and proceed with rehabilitation.
Another important lesson we learned about handling chronic patients is that it does not merely require clinical expertise. Just as important are the inputs from other healthcare professionals and the final outpatient care plan put together by the entire healthcare team.
As Dr Edward Trudeau so aptly put, “To cure sometimes, to relieve often, to comfort always.” Medicine has a limited capacity to restore patients to their original healthy state, and such is unquestionably the case for Mr Lim. Fortunately, he draws comfort from the unwavering support of his wife and Dr Loh, who have fought alongside him through the toughest initial challenges. In our eyes, Mr Lim is the absolute epitome of a motivated patient, and witnessing his progress certainly was a humbling experience for us.
A Family’s Love and Support Vital for Healing
Soo Jiunn Jye Roy and Too Jia Yu Sarah
Having just entered medical school, we were bright-eyed students fresh out of Junior College. We knew little of medicine, our knowledge confined to the “science medicine” we learnt in lecture theatres and anatomy hall sessions. We were unfamiliar with the perspectives of patients and the importance of communication, distant from the wards and clinics where medicine was actually practised. While we were taught the science of medicine in school, we saw the opportunity to learn the art of healing in this Longitudinal Patient Experience programme.
We had the fortune of working with our dedicated mentor, Dr Soh Shui Yen, who had vast experience specialising in paediatric oncology at the KK Women’s and Children’s Hospital. With her kind advice and assistance, we were given the opportunity to meet with and learn from a child, Jayden, who was only 6 years of age. He had been battling neuroblastoma and, after a year of intensive treatment, was on the path of recovery. We were told of the hardships endured by his family while he went through chemotherapy, and even after. He would be extremely irritable, lashing out at the family’s domestic worker, even hitting his mother. He was unable to attend school and thus had to drop out of the mainstream education curriculum. Thankfully, with the assistance of social workers, he was enrolled in a special school where he could learn and mingle with children his age.
We still remember Dr Soh’s words clearly – that illnesses like these not only affect the patient, but his or her family as well. Jayden’s parents would put in a significant amount of effort, taking him to and from school and the hospital for his weekly reviews.
We could only imagine the stress on the family, who had two younger sons to look after.
As medical students, we merely saw patients in clinics and hospitals and failed to realise that there was more to a family and their struggles outside a hospital setting. Visiting them in their home allowed us an intimate understanding of the challenges the family faced in caring for such a young patient. The father was providing for the family by working two jobs, while the mother held the fort at home by tending to their three young children. We saw the immense struggle the parents had to endure in caring for the children. In the short span of half an hour, the three sons fought, cried, laughed and bonded over toys. It took a lot of patience, cajoling, and pacifying to keep the boys in check. Through it all, the parents’ love for their children shone through and moved us immensely.
In medical school, we learn about the roles of doctors and nurses in providing patients with essential medical care. Through this programme, we have seen and understood for ourselves the importance of love in caring for the sick. We have gleaned from Jayden’s parents that loving care has its place alongside medicine in the management of patients. Therefore, as much as we should know how to treat with medicine, we should also know how to heal with love.
Acknowledgement:
Dr Soh Shui Yen, Department of Pediatrics, KK Women’s and Children’s Hospital