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.