What have we learned from visits to hospitals?

On 20170626, after Little Princess vomited thrice starting at 8.30pm, we rushed her to the main hospital with children emergency, where most parents in the country we lived in summer 2017 have brought their sick children to see a doctor, especially when general practitioners had closed. In the moment of rush, I still remember to bring mobile phone charger, which Honey Panda was thankful for.

We reached the hospital at ~ 9.35 pm, and a sign indicated that waiting time was expected to be 6 hours, but serious illnesses will be attended first.

At the hospital, she vomited thrice. Thankfully, her vomiting stopped at ~ 1.30 am on 20170627, but she was already admitted. Since no single-bed ward available, she had to stay at four-bed ward.

Different doctors assessed Little Princess, depending on their work shift.

The doctor at the emergency (surname K) (see *health*txt for full names), consulted his boss before told us to admit Little Princess. He examined Little Princess (press her toes, moist level of lips/gums, tummy) and shared that we did not have to worry about dehydration at that moment. We were thankful that he kept our queue number, because we went to buy drinks, he called Honey Panda several time, but his mobile phone has a problem for connection at that (important) timing.

The first doctor (surname S) at the ward asked a lot of questions, including the presence of birth marks and the occupations of the patient’s parents. She witnessed Little Princess’ 6th (and it turned out to be the last) vomit.

The second doctor (surname N) at the ward, who was gentler than the S, checked the throat of Little Princess. She mentioned that the procedure might wake the child up and did it fast. She noted that the throat of Little Princess was bit inflamed, most likely she suffered from viral infection. However, she also  ordered for urine test (to rule out UTI due to bacteria).

The consultant doctor (first name I) who came to see Little Princess in the morning of 20170627, brought some of his students. Green vomit may be due to intestinal blockage (bowel obstruction). However, in the case of Little Princess, her stomach was not bloated and she had stopped vomiting, hence it’s unlikely due to intestinal blockage.

Honey Panda informed me that their diagnosis procedure is akin to decision tree. It also reminded me on Checklist Manifesto by Atul Gawande.

It took the nurse half an hour to warm the expressed breast milk.When it’s ready, the milk was too hot, instead of waiting for it to cool down, I asked for a top up using that still in the fridge. Consequently, Little Princess drank higher volume of milk (~80 – 90 ml) than the reduced volume prescribed to her (50-60 ml every 2 hours).

Next time (though I hope she would not have to stay in a hospital again until she delivers her first baby), we can bring a kettle and a heat-resistant container, to warm the milk ourselves. Perhaps, they were very busy. Perhaps, they were under staffed, yet Honey Panda observed that he listened to nurses chit chat at the pantry. Honey Panda still gave a good feedback because the nurse was polite. It seems that being polite and showing empathetic can minimize negative feedback [2].

For her lunch, Little Princess received an empty bowl, which was not was we ordered for her. Thankfully, the neighbor’s mother asked if the cereal sachet on her son’s tray was ours as she did not order it.

Though we requested for a bumper to protect Little Princes from knocking her head against the metals of the cot, the bumper covered only less than half of the height of the metals. The active Little Princess still knocked her head, while she was cruising, in spite of our efforts protecting her head.

We were also worried for further infection acquired at the hospital because Little Princess used her mouth to explore anything, from the bumper to the metals of the cot.

Little Princess has the 4-bed ward for herself until the early morning of 20170627. Her first neighbor was a male baby ~ 2 months younger than her, who reached the hospital at 5 am. He was coughing, on an oxygen supply, vomited, and cried in pain for long periods. His mother is a nurse, it might help to soothe her.

Then, at 3 pm, a little boy with very bad ulcers in his mouth came. Honey Panda overheard that he might have oral herpes viral infection. The highly contagious herpes simplex virus can spread to others who touch infected saliva, mucous membranes, or skin.

Honey Panda asked a nurse when a doctor would come to examine Little Princess before discharging her. Since Little Princess is recovering, doctors would need to see more seriously ill children first, which we understood.

At ~3.30pm. another boy came in with his father, mother, and a maid. The ward became so crowded. Little Princess received too much stimulation. She did not manage to sleep much; as a light sleeper, she was woken up by the cry of the baby boy. At that point, I ponder on space, privacy, resources, distribution, and money.

I decided to walk around the aisle, carrying Little Princess with our baby carrier bought for Little Prince. Thankfully, they have some children-style paintings hung on the wall.

After a doctor examined Little Princess, while waiting for Honey Panda to settle the discharge matter, I brought Little Princess to breast center (clinic) at the ground floor of the hospital, because it has many empty couches. She fell asleep there ~5 pm.

We only reached home at 6.30 pm, what a relief!

***

On 20170628, Mom asked me if I know any lung specialist in a hospital in the country where we spent our summer 2017. At the same night, Honey Panda told me a news about a prominent oncologist who was suspended for giving a former 55-year old patient suffering from Stage 2B lung cancer false hope to undergo a chemotherapy; alas she died 6 months later.

Once they decided on their arrival date, I will make an appointment.

I don’t know any lung specialist [1], but will pray that we find one that is suitable for Dad and able to make right diagnosis and treatment if necessary.

***

On 20170717, after a long half-day (1-7pm) of accompanying papa to see a respiratory specialist and the worrying diagnosis, I felt that my mouth ulcer was worsening. I decided to use a traditional method of applying a pinch of sea salt on it. Tentatively, I can also make a cup of warm salt water mouth rinse. Salt is known for its antibacterial property and high pH.

***

On 20170720, Little Prince and I went to two hospitals. I had to shorten Little Prince’s first appointment as his maternal grandfather was waiting for me at another hospital. At the second hospital, in a busy lift, a middle age woman pushed through Little Prince and her bag hit him, he told me that he felt painful. Lesson: I must anticipate dangers and put Little Prince in front of me and/or use my body to protect him.

Then at home, I saw how the 2nd daughter of our selfish and greedy neighbor bullied Little Princess. I politely told her primary-school teacher father [4], and he was defensive. I pray to the universe that we will bump to them less and lesser in the future. Perhaps, this series of negative experience will allow us to appreciate our good neighbors more. It’s also a harsh reminder that nobody has the responsibility to be nice to us, and when we encounter nice people, we must cherish them.

Another observation was that in a competitive place where resources are scarce (e.g. the crowded lift at the second hospital, the birth country of Little Prince), people become less kind. Is it better for children to grow up in a competitive place/society or to enjoy a carefree childhood? [5]

In a nutshell, today (20170720) was a tough day, but at least papa found a doctor that he had a confidence in.

***

Thus, what are our action points?

  1. Love ourselves more. Cherish now and here. Increase our spiritual intelligence so that we remain calm.
  2. Breathe and exercise. I must do more gentle exercises (e.g. walking). I also want to try meditation, yoga, a novel physical activity that I have never tried, and make at least one of them a habit [3].
  3. Do not 100% believe the experts.
  4. Pray that we stay healthy for as many days, weeks, years as possible. Health is wealth.

***

[1] The more years I live, the more things I learn, I find it even hard to 100% believe in experts. I am no longer the little girl who believes what the doctor said.

While I no longer sure whom and what to believe in, a question popped in my mind: how do doctors face diseases and death? Most of them have chosen gentle death, without heroic measures.

I heard that doctors themselves are among the hardest patients. If facing a terminal illness, 88.3% of doctors would forsake resuscitation (i.e. “no-code” status) and aggressive, life-prolonging treatment (e.g. arduous chemotherapy, radiation), according to a study by Stanford University in 2013. Why? Perhaps, they have seen too much sufferings daily [2].

In contrast, another study by University of Colorado Anschutz Medical Campus reported that doctors used more hospice care, spent more time in ICUs than non-physicians.

***

[2]  Physicians are trained to deal with patients without much emotions, so that emotions will not obscure their judgments.

However, shall any of us aspire to be a doctor or any kind of high-cost service provider, it is good to know the financial risk of lacking emotional rapport.

In USA, physicians who are sued for malpractice generally make no more medical errors than those who are not sued. Interestingly, those who are sued have shorter visits with patients, fail to inquire about the patients’ concerns or answer the patients’ questions, have little or no smile/laughter. Remember to be empathetic, humble, nod, and smile if appropriate.

It reminds me on the duality nature of an attribute, nothing is perfect.

Doctors who have more empathy, can build better rapport with patients, “greatly increases diagnostic accuracy and how the patients comply with their doctor’s instructions, and enhances patients’ satisfaction and loyalty,” according to Focus by Daniel Goleman.

While the first obstetrician whom we saw in the birth country of Little Princess was meticulous, patient, and liked more by Honey Panda, I found her too emotional for a VBAC attempt. Later in summer 2017, I understand my decision-making at that time.

Attention to patients’ distress may affect how physicians in providing excellent technical care e.g. when a great focus is required to perform a particular medical procedure perfectly in spite of the agony of the patients.

I want my doctor to look at me if I’m in pain –to be there, be present to me, the patient. Empathic–but not too sensitive to treat my pain well“, Jean Decety of University of Chicago.

During consultations, most people including me prefer empathetic doctors. During the critical moment of delivery, I prefer less emotional obstetrician, who can focus and deploy acquired attentional anesthetic.

Attentional anesthetic appears to utilize the temporalpariental junction (TPJ) and regions of the prefrontal cortex to improve focus by disregarding emotions. In the brains of doctors, this anesthetic contributes to blocking or minimizing automatic responses to others’ pain and discomfort, that are normally fired in those who are not in the medical field. For example, when we see a baby  is being pricked with a pin, our pain centers in our brain are echoing that pain.

To meet with such a dual requirement for both empathy and attentional anesthetic, William Osler recommended doctors to practice detached concern. For example, a doctor should be able to detach himself/herself that his blood vessels don’t constrict and his heart rate remains steady when he sees terrible sights.

How I wish I knew about attentional anestetic and detached concern in my teenage years. I was concerned that I might end up feeling overwhelmed as a result of seeing the sufferings of others daily, I decided not to persistently pursue a career as a physician (one of my childhood dreams), besides the financial constraints.

***

[3] In summer 2017, I tried to have a daily walk with both Little Prince and Little Princess, sometimes we did not manage to do it, bu I am thankful for every walk.

[4] The father previously fed Little Prince unsafe-camphor-containing Zambuk while he was teething for biting people, instead of teaching his older children to avoid a little toddler who did not understand things

[5] According to a Hindu pilgrimage by William S. Sax, “People and the places where they reside are engaged in a continuing set of exchanges; they have determinate, mutual effects upon each other because they are part of a single, interactive system.

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