Wednesday, October 7, 2009


An Analysis Of An Unforgettable Experience

My experience as a carer of a chronic patient who is also my beloved mother, is an unforgettable one. I encountered this incident last year, when I accompanied my mother who was being admitted to hospital due to chronic heart failure. This incident made me realise the major role played by carers, and at the same time caused me to reflect on how patients feel.

During my last summer holiday, after I had my final year examination, I had to rush back home because I had news from my father that my mother was admitted to the Cardiac Care Unit (CCU) due to heart failure.

My mother, who has always been very healthy and energetic, had a dual-chamber pacemaker implanted in 2004 due to a history of hypertrophy obstructive cardiomyopathy (HOCM). Being a dedicated primary school teacher, she used to be active and busy with her workloads, duties and responsibilities. However, last year she was diagnosed with pneumonia that eventually exacerbated her heart condition. She was admitted to the CCU three times in two month. I accompanied her on some of her stays in the CCU.

Spending a total of eight days in CCU taught me many things. I witnessed death and dying patients with various heart problems and elderly heart patients without any relatives visiting. I saw poor chronic patients who were unable to afford the cost of surgical procedures and the required devices, and had to wait for financial support from the Human Resource Centre. Most importantly, how did it feel being a carer of a chronic heart patient, especially when the sick person was the person that I loved most; my mother?

Personally, I had the insight of being a carer to my mother. Besides that, I also learnt the dependency of chronic patients on their carers. I felt very sad when I saw many elderly patients did not have any relatives visiting, and they had to rely on the nurses to do everything; morning cleaning, assisting in eating and drinking, having someone on their side to talk to when they got bored, and most importantly, feeling supported and valued.

There was one day when my mother was on the drug trials, she suffered a very bad chest pain; sharp, centralized and continuous. This may have been due to the side effects of the intravenous drug prescribed. Since that trial, she almost gave up with all the medications given by doctors. She was afraid to experience the chest pain again. At this moment, I personally think that family members or carers play a very important role in giving continuous support and affirming the patients about their compliance towards treatments that will lead to a healthier state.

Most importantly, I realised that to be a carer of a chronic heart patient requires a person to have a strong inner self. Imagine that you are the carer of a heart failure patient, and you witnessed death and dying patients around you. At the same time, the person that you look after is also struggling for his or her life. I wonder how carers feel and cope, as I myself, as a medical student, was shocked to witness an elderly patient beside my mother’s bed die one night due to heart complications. As a medical student, I have been exposed to scenarios in tutorials and understand some of the aspects in dealing with chronic patients who are dying. In relation to the elderly patient who died at the CCU, I wonder how would the carers feel and how they found out about this situation. If they lose their strength and started to think negative, the effects would be on patients.

Being a full time carer makes me think about the support needed by both patients and carers. I was so lucky to have all my friends and seniors, most of whom were interns and medical students. They would understand my mother’s condition both clinically and emotionally. They were always calming me down, lending me their ears and offering their shoulders to cry on. Undoubtedly, sometimes I would feel paranoid and think about the worst of everything. Being a medical student cannot make me run away from being paranoid about sickness, death and dying. Although I had all the medical knowledge and depth of understanding about the issue, it was still hard to face the reality and try to be positive all the time. However, I had no choice other than facing the reality. I had to be strong in order to make my mother to stay strong.

As I was accompanying my mother all the time within the 8 day experience, I got the chance to socialise with some of the elderly patients there and give them some help. One of the ladies, who was hospitalised on the same day as my mother, told me that she was glad and touched to see me accompanying my mother all the time. Therefore, I was thinking about how the patients feel when they have no one to talk to in the hospital, especially in the ICU, where most of the patients are struggling for their own lives. With all the medical equipment and machines surrounding them, and all of the healthcare staffs busy with their own duties, they would surely have no time to talk to the patients.

One particularly demanding thing was the strength needed to keep both my mother and myself to be emotionally positive. At the same time, the bond and relationship between my mother and I was also vital in making sure that my mother would comply with the treatment.

Reflecting back on the incident, I clearly remember about my condition at that moment. I had missed my night sleep almost everyday. My mother had difficulties sleeping at night in the hospital, because she said that if she had shortness of breath, which is quite common among cardiac failure patient, at night, then no one would realise it. Therefore, I kept my mother company, talking and chatting at night when she could not sleep.

Personally, at first, it was hard for me to accept the fact that the person that I used to rely on to share my problems with and seek support now depended on me to give her strength, and most importantly, the strength in continuing her life.

All this while, being a medical student, I always missed looking into the importance of support needed by both carers and patients as an important branch of treatment and management to gain the best health outcome.

However, I am glad that I had learnt something from my mother’s situation. I will always look at patients’ need of support and the role played by carers in providing good care for the patients. Besides that, another important aspect is the support gained by the carers. All of this will eventually lead to the patient’s benefit and the best outcome for them.

It has helped me to think laterally in the management of patients, not only to look at the medical model of the disease, but try to approach one case holistically, taking into account the carers and everyone else around the patients.

Besides that, I also realized about the important role played by doctors and nurses (medical staff) to be able to understand how the patients feel and try to tolerate and get a good insight into the patients. By doing this, a good rapport will be established and at the same time, patients will feel supported and valued.

Apart from getting the insight into how your patients would feel if they do not have any relatives or friends visiting and giving support, a medical practitioner should try to think laterally, to figure out ways that could make their patients comply with treatments and medications. When a good rapport is built between the medical practitioner and the patients, the process would be easier. Another aspect that should be looked into is support networks and the current state of the carers. Do they need support? Holistic approach towards a particular disease is the best way to describe this particular issue.

Apart from that, as a future medical practitioner, I would try to get a better insight on how the patients would feel and how do they comply with the medications. It is important to think about all these issues in order to get a better compliance that will eventually lead to a better health outcome for the patients.

***Actually when Nadiah sent this essay in my email, I was very excited to read it. She had told me before that she received compliments from her lecturer for this Critical Learning Incidence essay which is supposed to be her assignment. So, after persuading her to let me read it, I wish to share her story with my blog followers. As her mother, I was so touched by the essay. Without realizing it, my eyes were filled with tears and how my heart wept as I was reading it for the very first time.. Praise be to ALLAH for having those four girls and a boy as my children. I am very pleased and thankful to ALLAH. If at this age, they managed to show their care and concern towards me, God knows what it would be like in the future, Insyaallah. Syukur Alhamdulillah...