Sweetest Downfall

Bruised left cheek, lacerated and swollen chin, sprained elbow. Waiting in A&E.

Well where do I start this self-embellish enlightened experience. Let just start with the painful excruciating fact that…

“I slipped myself at a foyer entrance of PKNS Complex buiding, hit my left jaw and cheek on one of the steps and fall on outstretched hand (FOOSH).”

There was an Indonesian woman having a fight on a phone sitting on the stair and I fell down right in front of her. She went like “Ya Allah, adik” and hanged-up her phone wanted to help me. On a sheer embarrassment and adrenaline rush, I stood up immediately wipe my face clean and shake it all off before I went to continue my journey, to bus station.  I didn’t realize the pain until I arrived home, I couldn’t move my left arm and I relied heavily on my right. I was lucky I thought, have it been my right, I will be severely handicapped. I told myself that I need to go to emergency department ASAP, I might sustained a concussion as I recalled that my left face hit hard on that edge of stair. There was a bruise on my left cheek and contused hematoma on my left chin. Luckily my growing goatee covered it. There’s a slight cut though.

I am confused, I can’t still wrapped my head around what happened but I fought my way around. I shall clean myself first before return back to HTAR I said to myself, it was 6.30pm. The pain was so severe that flexing my finger was torture. I couldn’t even wrap towel around me. With much struggle, I changed my working shirt to casual, packed my stuff all with full capacity of my right hand. Oxford Handbook of O&G, Shaw’s Gynaecology Textbook, face towel, bath towel, face wipes, hygiene wipes, a bottle of perfume, my tablet charger, my MSU I.D, just in case if I fractured my arm and need to be admit.

Now where do I find transport to A&E? Luckily there was one taxi waiting, it was a Malay seasoned driver. He hesitates at first, but when I told him about my condition, he agreed to send me to HTAR. It was every taxi drivers' nightmare to drive to Klang at this time of day, and I understood. But I am again so fortunate that traffic was not so congested that time. We chatted along the way, he told me last time he went to HTAR was in 2001. Where his wife passed away succumbed to cancer. Two years before in 1999, his daughter died of MVA in HTAR too. So went back to HTAR is painful for him, but he did it for me. He dropped me in front of A&E lobby, gave me his business card in case I wanted someone to take me back to Shah Alam. I thanked him.

I went for registration at Triage counter, having my EM posting there, I understood the system. Triangular bandage was wrapped on me and I sit down to wait for Secondary Triage. While waiting, I flipped through Shaw’s Gynaecology Textbook, I have seminar the next day so I need to read about it. I got mild headache, part concussion, part caffeine withdrawal; tried to distract my head, flip through. People around stared at me, I didn’t moan and groan or cry at pain, I am fine, as long as I keep my arm still. On Secondary Triage I was attended by a housewoman, the system has changed. It used to be run by Medical Assistant back then, must be lot of mistriage that shook the system anew. I told the needed history, having finished my Orthopaedic posting just a week ago, I wanted to save her time. I told her the mechanism of injury and I have reduced sensation of on my left hand, and it started to get colder than the right one. She brought me to Yellow Zone and consult the EM MO, a familiar face, he asked me to go get X-Ray which I went alone. AP & Lateral view manoeuvring was excruciating. Five minutes and I’m done, I went back to Yellow Zone with a film on my hand.

Luckily upon my self-observation no intraarticular or shaft fracture, no dislocation, I am expecting a simple sprain. I am so relieved, and that somatically reduced my pain. I now realized the importance of assurance in medicine, when you reduce your patient worries, you reduce half their pain. Some pain not necessarily physical, it’s the scare and fear of unknowing outcome that add to existing insult.

So I waited in Yellow Zone while observing the crowd, all those HO at their last housemanship posting working so competent and busy MOs consulting here and there. I constantly checking up on my CRT and nerve function; I’m performing OK sign to check my median nerve, thumb-up for radial nerve and adduct and abduct my finger to check for ulnar nerve function. It has been weak, but not deteriorating. Pain has something to do with it.

I sat next to an Indian uncle, I chat cum clerked him, he woke up at 4 pm and lost sensation and motor function of his left arm, his wrist dropped but currently he slowly regaining function. Got himself a CT scan earlier, waiting for report. A chronic diabetic, he lost his left leg and wear prosthetic. That uncle guess that I am a medical student by the way I questioned him, and I confess to him that I am on my final year. My diagnosis, TIA.

Sitting in front of me, a middle-age woman coming with swollen lower limbs and inability to pass urine, she vomited once at home. She has chronic renal failure was on every other day dialysis. Her mother has CRF so does her siblings, her eldest sister died of CRF complication.

There’s a fully covered Malay (niqab) lady with a fretful and crying son, less than 1 year old. According to her, he stepped on hot oil and burnt both his left and right foot. It was scalded, the blisters have ruptured. Her husband waited outside. She was asked question about mechanism of injury. She gave different inconsistent answers, she even stop a while waiting for the doctor to suggest possible mechanism and she paused and agree, first the houseman than came MO. It puzzled me that if his son was on a walker as she told, how did he able to come to contact with hot oil. Was there hot oil on the floor? Was she cooking on the floor?  How come he only injured his feet. It looks like that his feet has been dipped into the hot oil on purpose, I don’t know, it beats me what extreme religious person will do. It was when the sister came and question her again that I realized that the doctors suspected it was child abuse.

Next, come one petite Indonesian lady barefoot with bloody hand and face. She was a pedestrian hit by a car. She was badly shivering, some adrenaline, so I took a blanket from a nearby empty bed and gave it to her. I help wrapped it around her and her feet. The Indian uncle sat next to me teased me “Bila you jadi doctor nanti, saya nak pegi hospital you kerja. You take a good care of others.”, I smiled and replied him “Tolong sikit-sikit je uncle,”. I wasn’t even feeling my pain.

Then there is Chinese uncle came with complain of shortness of breath. He was another patient of renal failure, there was nasty weird looking rash interjected by senile pigmentation, and bloody punctured marks on his forearms. He is also in EOD dialysis. I offered my seat to his wife.  

When the doctor consulted me confirming me that I have elbow sprain, and prescribed me voltaren and LMS cream, I am relieved. The houseman ask me if I wanted MC slip, and I politely refuse as I planned to attend next day session, where I need to present my seminar. So there I go dragging my bag out after saying goodbye to those people I just met.

It was 9.20 pm and it was raining outside. I have no transport home, I am considering calling that Malay taxi driver, Pakcik Mansor to drive me home but I think I should try wait for bus first. So I brave the rain and wait, it has been 20 minutes, no bus. An Indian auntie sat next to me, I asked her if there will be any bus at this time. She told me there is if we are lucky, so we chatted. She was visiting her relatives admitted in medical ward, he is 70 year-old and very sick. I planned to take a bus back to Shah Alam from Bandar Klang but she told me there was unlikely any bus left, she suggested I should take commuter with her instead and I agreed. I never ride commuter from Klang before so I don’t know where the station is, so might as well follow her.

When we stop at little India, I just walk behind her, she was making way for me through crowded sidewalk so those people will not bumped into me given how bad she perceived I look with a bandaged arm. It was still raining, she hold her foldable umbrella but she didn’t use it. I asked her why didn’t she used her umbrella and she told me, since her umbrella too small to share with me, she felt bad using it on herself, so she rather both of us wet. I was touched on her gesture. I insist her to use it telling her that I am young and healthy, it’s okay for me.

When we arrived in Klang KTM station, the last trip was on 10 pm, ticket counter closed, ticket machine not functioning, so she told me that we shall just wait for the train, and we can pay our fare at station where we’ll disembark. That Indian auntie left at Station Padang Jawa after wishing me good health and I thanked her for her courtesy.

When I went down at Station Batu Tiga, counter closed no one was there, I assumed my commuter ride is free, lucky again. So I just pass through the gate and look for taxi. There were crowd waiting for taxi, only two taxis available and there were people haggling with taxi drivers.  As we all know taxi driver will use this opportunity to charge more and refuse to use meter, so there were quarrels. I went to a Chinese male taxi driver who just finished fighting with and Indian guy. I am lucky that he willing to take me  home, given there was a lot of people waiting earlier than me and they were soaking wet. I am so lucky.

In that taxi, there were another two passangers. On a front seat, was a Chinese man and sitting next to me at the back was Chinese lady who preoccupied with her handphone. Along the way, that Chinese driver vent his displeasure about his prior argument with that Indian guy. I think because he expected me to be Chinese, he talk in Chinese. I can’t understand the word but I can safely extrapolate from the tone and repetitive bigotry ‘K’ word that he was badmouthing that guy and he is a racist. I kept my mouth shut, so does lady beside me until he dropped me off.

I felt so hungry, so I went to buy char kuey teow, I’ve known the couple for sometimes now but our conversation never exceeds “Pakcik, char keuy teow basah satu bungkus”, “Semua nak?”, “Aah”. Today upon seeing me walking to their stall, they stop working their woks to ask me what happened. I told them everything and they gave me such sympathy gestures also complimentary char kuey teow. I am humbled by their kindness.

I went home, eat my late dinner and try to type my seminar with only one finger. It took a while to get adjusted, and as I wrote in my FB status, I was thankful for bilateral shift and ctrl keys. I am so tired and in pain, having been sleeping for 30 minutes the day before, I succumbed to my body resting call. I went to sleep with seminar half-done. In the morning, I woke up late and my left arm worsened. I asked my group to try to carry the seminar forward to another day and text my lecturer on my absent. So I continue sleeping, losing capacity to shift left and right.

I relied everything on my right arm and hand, and find out it wasn’t so hard. I can do my normal chores with no difficulty. My elbow was fixed on semi flexed position. I couldn’t fully extend and fully flex it. When you injured your muscle, it will become contract and refuse any movement that will aggravate pain.

Today (Wednesday) I went to weekly night market wearing skin-colored crepe bandage around my injured elbow, I quit the sling bandage because I don’t want to attract attention. I went to my favourite Nasi Ayam stall, the owner asked me about my arm, and his mother express her sorry for my condition “Macamana doctor nak rawat pesakit kalau tangan dah berbalut macam ni,” she politely joked and I smiled. She  is the mother of my patient back in 2010 in Medical Ward HTAR. Her son has Type 1 diabetes admitted for hypoglycaemic faint. I haven’t seen him helping in the stall for a while now, last time I asked her about his whereabout, she told me that he’s been working somewhere.

The Things I Learned with My Injury

• Be careful when you walk, make sure your shoes or slippers have a good anti-slippering grip.
• While it is good for vanity, flooring tiles used in some public place should have dragging surface to keep people from slip and fall. While it is good to keep them shiny and waxed, always remember it can be slippery when wet. The tile in the front foyer of PKNS Complex is freaking slippery, if I am of a Western-minded people, I’ll sue the ass of building owner.
• You can do everything with only one arm and hand. God (the Most Merciful) being so generous giving us two arms and hands. You need to be resourceful and creative.
• There are two ways of looking at things, either you wanted to take it negatively or otherwise.
• I learned about people more and realized if I just open myself to others, you can learn a lot of things.
• I can rest assured, in a time of need and misfortune, you can rely on our society on being merciful and kind-hearted. That one goodnight sleep for me.
• Strangers can be a good caring people if you let them.
• Being independent has its own perks. You don’t have to trouble others at a same time you know that when you have no one to take care of you, you can always rely on yourself. My father used to say this “Hidup kena berdikari, jatuh bangun sendiri,”
• There is a lot of people out there who are actually care about you that you don’t know of.
• Being in pain, doesn’t mean you have to sit around and be lazy. I typed this entry forcing my left fingers to work after some position adjustment, I need to utilized them or I’ll lose its function to contracture. Use or lose.
•  I am so thankful for my Orthopaedic posting.
• If you think you had it bad, there are someone somewhere who had it worst. So be thankful and grateful. As long as you not dead, you are OK.

So it is just befitting that this is my sweetest downfall. I felt blessed with my injury. I learned a lot. Alhamdulillah.