Yesterday I saw a patient who was referred for “adjustment of antibiotics” ~ ID people get a lot of this kind of referrals, especially when the patient remains septic after being banged by all kinds of antibiotics by the primary team.
The patient is a young woman who just a week earlier, began to feel unwell and within 24 hours developed several fitting episodes, rendering her semi-conscious by the time she was eventually brought to the hospital (after visits to 2 GPs and 1 other hospital). She has a history of SLE (Systemic Lupus Erythematosus) which was under control, according to her husband. A contrasted CT scan of the brain showed meningeal enhancement and a lumbar puncture revealed the presence of bacterial meningitis.
The husband was hovering anxiously outside the patient’s room yesterday in the ICU when my team and I arrived. We didn’t speak to him initially as my team and I went through the thick pile of clinical notes as well as examining the patient. It turns out that the husband thought I was a Malay and because of his language deficiency, he did not try to talk to me.
When he found out that I am a fellow Malaysian of Chinese descent, he opened up freely.
Clutched in his hand was a tiny recorder containing a tiny cassette. In the cassette was recorded the baby sounds of their only child who was born a little more than a year ago. He asked if he could place the recorder by his wife’s pillow so that she could listen to her baby’s voice, even though she is heavily sedated and ventilated on a machine. The husband hopes that by listening to the baby sounds, she might be encouraged to pull through and quicken her recovery.
As we talked on, I could see the man has realistic insight. He is aware that his wife’s brain is being ravaged by a bacterial infection; her seizures are being controlled by massive doses of a few anti-epileptics, her breathing is being controlled by a machine; that there is evidence to suggest that she is having another SLE flare up and that all measures are being taken to treat and support her.
He had no illusions that his wife is very sick indeed.
And yet, none of that concerned him. His only concern was this request:
“Doctor, can you please remove the splinter in her right big toe. It got embedded into her toe when we moved her from our house to the hospital. Please remove it because I am sure it makes her uncomfortable and she will have pain!”
My initial response was to brush it off. I mean, compared to status epilepticus, a severe bacterial meningitis, a SLE flare up, mechanical ventilation and the possibility of pneumonia, ongoing sepsis, etc etc, what is a mere splinter in a toe?!
And then, it was my turn to gain insight.
The husband was doing what was in his power to do and leaving the rest to the doctors and ultimately, Almighty God.
What he could do was to bring a cassette bearing their child’s voice and a request to have a small splinter removed.
I gave instructions to the nurse to have the splinter removed (I would have done it myself except my vision isn’t all that great, I might end up removing the nail!).
It’s a good lesson learned.
I was told that the fluttering of a moth’s wings may set off a hurricane on the other side of the world. We may not be able to change the big things (like whether a government changes or not), but we should do what we could do, no matter how small to effect changes.
One vote could topple a government.
One act of kindness can bring massive relief to those who suffer.
Wed, 170908 @ 0745; on call today.