Memorable but not in a good way

I have one patient that I think I'll remember for a looong time.

She is 56 years old with Alzheimer's dementia. She has minimal communication apart from yes, no and crying. She came in one day with "abdominal pain". When trying to examine her, no one could really elicit WHERE exactly the pain was. One day it was upper abdo, next it was central abdo, then it was right sided and then sometimes it would be everywhere.

Her blood tests were normal. So in the 3 weeks she was there, she had:
1. Abdominal ultrasound
2. Pelvic ultrasound
3. CT abdomen
4. Diagnostic Laparoscopy (masuk camera in abdomen, this is an operation okay!) and took out her normal appendix
5. Colonoscopy (telescope up the bum)
6. Gastroscopy (telescope down the throat)
7. Repeat CT abdo
Everything was normal. But she still had "pain" requiring high doses of morphine.

We had the physicians see her, the anaesthetists in the Acute Pain Service see her- they all said it wasn't pain but maybe just distress from the Alzheimer's. We noticed it too. I mean, she's only be crying if we came to the bedside. Other times she'd be quite alright (when observed from afar).
They were able to push on her tummy really hard and she did not complain.They told us to stop the morphine because she really didn't need it. We stopped the morphine.

The family was MAD. Nurses were MAD because the patient kept crying and causing grief to the family; who in turn caused grief to the nurses who in turn got angry with us doctors for stopping her morphine. We gave her diazepam (Valium) instead and guess what...that worked. I bet you if we gave her sugar pills, she'd be fine too.

The family wasn't much help either. Everyone hated them. The husband was an overbearing S.O.B who treats everyone like we're all so incompetent because we couldn't find anything abnormal in his wife. Shouldn't he be glad there was nothing abnormal? And it's not our frikking fault that everything's normal! We did all the tests known to modern medicine for investigation of abdominal pain. He even pulled the collar of my registrar's shirt because he was angry at him for telling him we couldn't find anything wrong with his wife. The nerve! Halau karang baru tau.

The patient's sister was a pharmacist who kept telling the nurses and pharmacists what to do all the time. The nurses were all so annoyed. I'd be annoyed too. Act like relative; you are not employed as a pharmacist in this hospital so just be the sister for crying out loud. They were also questioning why she wasn't getting blood tests done every day bla bla bla. I had to explain to them that we don't do blood tests randomly; there must be a reason why we'd do it. And hers were all normal. You know, all the other patients complain about having daily blood tests. And this one was spared but still the family complained!

Because her hospital stay was so prolonged, the patient then got
1. A urinary tract infection
2. Wound infection
3. Sweat rash
Things that would've been avoided if the family hadn't insisted on her staying that long.

What was so frustrating about this patient was that the family wouldn't accept our diagnosis that it was probably psychological. So we couldn't:
- refer to a psychiatrist
- send her home!
All of which would probably have solved the problem since Day 5 instead of Day 21. And now because she was just waiting around in hospital having tests which were unnecessary in a bid to appear like "we were doing something", she's got all these hospital acquired infection which is much worse than the problem she came in for.

We had to call the Director of Surgery to come and discuss with the family and suggest to them to take her home. I wasn't at the family meeting - didn't wanna be! So the family decided to bring her home. The nurses were so happy they were rushing to do all the necessary things required to discharge a patient! I had her discharge summary prepared for days already. I made sure the discharge summary was extremely detailed so that they will not be tempted to make litigations in the future. That wound infection for example. That's not our fault. If the family weren't so insistent, she wouldn't have needed to have the diagnostic laparoscopy that caused the wound in the first place. And if the family had followed our advice, they'd brought her home and the wound couldn't have been contaminated with hospital bugs anyway.

When she was gone, everyone rejoiced. We should've had a farewell party to commemorate the occasion.

Lessons:
1. Short hospital stays are the best. The longer you stay, the more likely you will catch the germs around in the hospital. Yes the hospital is disinfected, but that's why the germs are more resistant. Because they've been exposed to disinfectants, sterilisation and antibiotics! And they can't be 100% eradicated because most of them are naturally living in the noses and skin of health care workers.

2. Please believe the diagnosis. If you don't believe it, then go to another hospital. SERIOUSLY go to another hospital.

3. Having more tests doesn't mean it's the best way. Tests are invasive and come with risks of their own. Look at the list of tests this patient had done. It's a miracle she didn't get a perforated digestive tract with the colonoscopy/gastroscopy. Or bleeding or trauma with the laparoscopy. Or anaphylaxis (extreme allergic reaction) to the CT scan contrast drink. Or scarred veins from all the blood taking.

4. Be polite to the staff. We are only trying to help. If you are overbearing and obnoxious, people avoid you (and by proxy, the patient too!). Like I tried my best to avoid going to her bedside at all. If I saw her name on the whiteboard, I'd groan and run in and steal the drug chart and do whatever and leave the drugchart at the nurses station instead of returning it back to the bedside. It was that unpleasant. The relatives did complain that they thought we were ignoring the patient. Well, bingo! That's your doing! Sedar la diri skit!!

Anyway, this patient is truly memorable. 2 days ago I saw her name back on the emergency department's patients list. I was nervous!! Then I was told, she will not be admitted into this hospital and will be transferred to a private hospital. What relief!!!!! I'm sure that private hospital will make a lot of money out of her.