Wednesday, March 25, 2009

Pearls & Gem : Remembrance of Death

Today I was told by Shan, my clinic PA that Encik BL, a regular patient of mine just 'passed away' in his sleep yesterday. He was just 54. In robust health despite a major 'heart attack' some 4 years ago at which time I had implanted, as an emergency procedure, 2 brand new, costly, drug eluting stents each in his right coronary artery and his more important left anterior descending artery. Emergency because the left one showed life threateaning proximal 100 % occlusion the day he presented to us at ER in the wee hours of the morning in June , 2004.[ Emergencies have the peculiar habit of coming in the wee hours of the morning when the rest of the world were happily on cloud nine ! ]

I was 'rudely' shocked because I saw him a week earlier in the best of health, he, talking about his impending retirement in September, and myself, persuading him for the third time to undergo a check angiogram, the earlier the better in view of a positive stress ECG done some 5 weeks earlier. I am not a 'prophet' ,and the art and practice of medicine is far from being an exact science', thus I could not say and quantify with certainty the 'urgency' of the 'weakly positive' stress ECG. At the 'highest level , the private discussion between doctor and patient at least at the outpatient clinic scenario, is' intuitive and gut feeling'.

The big jump to 'exact science' lay in the court of the patient upon recommendation of the doctor. When further invasive procedure is thought necessary and recommended, and if especially involving risk and high cos , there is a lot of cajoling and' horse trading' going on . It would be an easier life for us doctors if decision making in medicine is black and white [ as in law ] but in practice, there is a whole load of grey areas in the' soft science' of medicine. The science is easy and universal, the art in this caring proffesion requires years of 'wisdom collection'. 'Intuition' and most importantly' intellectual honesty' are premium values.

Most doctors, would be able to sleep better if all their patients listen to advice but there is no way we can force things into our patients' throats on just the basis of 'qualitative analysis' especially in a situation when the recommended procedure itself [eg . coronary angiogram with a view to invasive corrective balloon angioplasty and stenting, if deemed urgently required ] carries a very small but finite 'mortality risk'. In such scenario one can spend hours discussing the potential 'cost benefit ratio and analysis' but at the end of the day , patients , like Encik BL ,would rather sit on 'things' and procrastinate, to their own detriment. By all mean get a 2nd opinion or even a third , but never sit and sleep on a serious 'advice'. Some serious medical conditions , like heart, brain conditions or cancers are' silent conditions' that kill ,unlike toothache !

"Ces't Dieu Qui Direct": We plan, God Direct. I think BL died of a 2nd heart attack in his sleep .

This brought to mind another dear University colleague of mine, several years my senior at First College UM [ Datin Sri 'R' was there as well , I am positively name dropping here!!! ] , in the early 70's. Saw me some 15 years back for a check up while on his way to catch up a flight to Sarawak at the then Subang Airport. Positive stress test, no symptom of angina to warrant urgency. Flight in half hour's time. Important meeting in Sarawak over Petronas/Esso production sharing etc etc.

"Definitely will see you next Tuesday, Doc. Cannot miss this , meeting . Will see you after I see Hassan on Monday". I went scuba diving in Tioman on Sunday and latter at dinner read that head of Sarawak Petronas died over the weekend while attending a dinner . Innallillah hiwainnailaihirojiun ! Had to live with that 'sinking feeling in the heart' for years whenever I see his widow who used to live in the neighbourhood.

Ces't Diue Qui  Direct.

Which also reminded me of my dear cousin's demise just exactly a year ago today. Datuk Dr Nik Zainal . Effervescent,flamboyant character, full of life. A life of public service. The 1st ever Malay cardiologist. Whenever I passed by the the junction of the Karak Highway meeting the old KL-Bentong road, my mind thought of Nik Zainal. How could he, a very caring doctor par excellence , careful person and not a 'hurried' kind of driver, missed the oncoming trailer ladened with logs? He was fasting the 'six day fast' that day and it was 5 pm. His vision could be 'clouded'by hypoglyceamia [ low blood sugar ] ?

I wondered loudly to my sis-in -law one day and was 'brought back' to reality: " C'mon Howk, don't be stupid, that is just cause and effect, Izra'il had been looking at his dairy for hours, waiting for him near that durian place you always like to stop for your monthly 'Musang King'. Abe Deen certainly had no chance, fasting or no fasting "

Mashaallah, Alhamdullillah, Allahuakbar, even Nik Isahak, the big time doctor from that five star hospital, also oftentimes need to be reminded that when one's time come there is '' no delay or hastening of even one millisecond''. The 'cause' is just the 'science' of Allah.

Make me wonder, just thinking laterally, whether the 'profound insight' that Izra'il, is always carefully studying his dairy for any last minute' inclusion or exclusion' [ or 'event organizer' if you are IT inclined ] from his "Boss', could make any difference as to how we approach life . Visiting us some 20, 30 times in a day, and this is common knowledge to those intelligent 'people's rep' in the hallowed hall of Putra Conventiotion Centre today, whether that would make them less interested in jockeying for power and ultimately practice less money politics. But come to think of it ,how many of them care despite so many Abduls and Siti's from amongst them ! Some would even 'stab their brothers' in the back or even figuratively 'kill' to taste power.

Power corrupts and absolute power corrupts absolutely. But then again,It is just human to plan, Allah ultimately decides.

PS : Funny what happened at Ameno Youth level! KT's group said KJ won by 'rasuah'.MM's group thought both KT anfd KJ practiced 'money politics. Young 'gangsters' at work. No honour, integrity nor accountability. It is frightening for all of us that clowns like these would run Malaysia in 10 years time. Ameno has not changed. Corruption is very much the order of the day. A party cannot really depend on 2500 numbskulls to elect the future PM of Malaysia !Ameno is doomed. Too many clowns running the show.


Anonymous said...

DEar Nick,

Memang benar, kita merancang, Tuhan menentukan.

Feb last year, I lost my younger bros in Melbourne at the age of 52.He had quadriple bypass at Ampang Putri in 2002. When he passed away, his wife found cigarettes in secret compartment of his bag. He had not been smoking in public for years.
His twin brother had a massive ACA at the age 39yrs in Langkawi. He came from Shah Alam on duty to conduct seminar and visiting me. When I was informed, he had a heart attack one hr after arriving and was admitted to Langkawi Hospital, while I was still attending patients at my clinic. Confident, a first attack would be a minor one, after all he was just 39, I hope to see at the so-called ICU, instead saw him at the mortuary.

Al-Fathihah untuk semua.


Pearls & Gem said...

Wow! You guys have that kind of history.

With that kind of family history, could you please remind your other younger brother to come and see me.

The last time i saw him he was highly stressed and highly strung +++[ querrel with his neurologist , cannot wait ]. His threadmill was normal but he had hypertension and if I can recall correctly ,newly found diabetic. heavy smoker as well .

Forgotten his name Rachmat but certainly type A personality. dangerous character.

I want to see him .He has absconded my follow up ,that other younger brother of yours.He should be in Langkawi, writing like you .

Anonymous said...

Dear Nick,

My youngest brother you meant, Rohiman Haroon, award winner script writter. Few years back he won 20K Finas script writting competition.
The one passed away in Melbourne last year had not seen you. He was former Ketua Pengarah National Art Gallery. Avid art collector. From a private person to a G-man, he was directed to see cardiologits at IJN. No personal doctor. I believe that how problem started. From Ampang Putri to IJN.

For my youngest brother, I told him that he had been attended to the finnest neurologist in the country. He was so mad, the doc didn't inform him that he had minor stoke but inform his office about it.
He left UMW as a corp director to another company. As his new company is US-based, like 5 million Americans, he was asked to leave for a mere compensation.

Likely he'll start writting again.

I've tried to convinced my three young brother to stop smoking and take baby aspirin daily.
I told them, I've been taking low dose aspirin since 1985 while double blind study was still being conducted for participating American doctors. I didn't wait for the result. We knew the outcome before hand.

Anonymous said...

Salam Dr Nik, no hu hu this time since you are so sad.Do not regret those who have gone, they are with their almighty Allah.I am a coronary patient and you know it (since you were my doctor).
Redha, that is the keyword.I have prepared my wife and young children for my early death.While waiting.. enjoy the life...salam takzim

Anonymous said...

dear Nik,

Read my first English novel @
I just created my blog. And only publish the first chapter.

Pearls & Gem said...

Yes Rachmat .I meant Rohiman .Angry young man, I sense. Dangerous character. A liability to his heart . Start him on statin and low dose aspirin.I think he is also hypertensive .Bad road in Damansara Heights also can mean bad roads in TTDI and Pucchong as well. Bad PWD !

Fiz, bukan sedih . Saja suka ingat2kan kawan dan diri sendiri. Kita di KL especially move very fast, mata hidong anak dan isteri pun kadang2 tak sempat jumpa .Sibuk cari makan . Walhal Izra'il dok jengok kita 24 kali sehari.Bila nama si anu bin si anu nak naik dalam dia punya handset !