Tuesday, February 8, 2011

Unto HIM is the journeying.....

My favourite patient and friend AFW died yesterday while at home, presumably from a 'massive heart attack'. He was 43. Our path crossed when he had his 1st coronary event at a tender age of 37, a young, thinking, up and coming CEO. Had 4 stents implanted in 2005. Bad residual Left ventricular function[ short form to just 'LV', for left ventricle of the 'heart', the main 'piston' pumping your blood away ] following the loss of heart muscles during the 1st attack.

When I am faced with young chaps like him with reduced LV function, apart from the usual standard care for the'body', I always felt duty-bound the necessity to address the question of the 'soul'. Unwanted , unheralded, unexpected death does occur despite the best of care and surveillance in people in this group arising from arrythmias, sudden non-critical plaque disruption making a non significant and minor plaque or indentation in the coronary vessel suddenly critical narrowing or complete blockade, leading to a life threatening reinfarction, and rarely 'pump failure'. From the 'mechanical perspective', increased mortality arise from this group of patients higher than the rest because with a prior 'LV dysfunction', their hearts have less 'reserve' so to speak to be able to sustain any further loss of muscles arising from a second heart attack. In layman's term, 'you are already on reserve tank'!.

If he is Muslim and Kelantanese, it is usually easy , this 'education of the soul aspect : Just blurt out, the usual advice usually given to big bikers, " Jangan Korner 'baring' in your lifestyle " would automatically be followed by a 180 degrees turn towards piety, surau going, comtemplative,dikr laden change. If you are a big bike enthusiast and like to 'potong' people around corners, you automatically know what it mean.

If he is non-Kelantanese and Muslim, this " Jangan korner 'baring' .." advice is rarely understood. Instead I would advice him to take a one kilometre walk to his nearest surau for Isyak prayer for 4 to 5 times a week. That address the exercise issue at the same time.

If you are non Kelantanese and Non Muslim, my task get a wee bit harder. Firstly I have to make a rational assessment as to whether my patient is ready to accept the less than satisfactory news of possibility of future SCD [ our euphemism for sudden cardiac death ]. After having ascertained that only than would I venture gingerly over the issue. Most would rather have me remain silent on this important issue. This give doctors in my position a wee bit of heartburn in the long run because ' silence means a heavier emotional burden for us' when untowards event occur in the future.

That in a nutshell is the 'state of the business'.

Back to my friend AFW. He is non kelantanese but Muslim. He probably must have been close to big bikers though because he understood the " No korner baring " advisory.
His lifestyle according to his elder brother whom I talked to today, who is also my patient, changed 100 % after his 1st coronary. Umrah yearly for the last 6 years, Ramadan in Mekkah/Medinah, prayers and dhikr and a life of contemplation. Alhamdullillah!

His untimely 'pasasage' has left a gaping wound in my 'qalb' today but it is quite reassuring to know that he has gone to meet his Maker on a good 'inning'. Alhamdullillah, Mashaallah!

Inna lillah hiwainna ilaihirojiun. Unto HIM is the journeying.


Anonymous said...

Doc, refer to your blog by a friend of the late AFW.

Interesting to read your posting since I've quite similar problem - 40%+ block at the right side when undergo angio in Nov 2008. No stent inserted but on medication since then.

Now try to avoid to duel too much about this problem & try to take the day as it come.



Pearls and Gem said...

Dont worry Abang Chik
See your Doc. 'Sack' him if on your follow up you find he is just happy that your total cholesterol is just below 5.

Exercise , exercise, exercise to push up your HDL Cholesterol to as high as possible. Keep to ideal weight [ height in cm-100, plus minus 4 Kg ], Statin to keep LDL below 2 mmol.

If you are diabetic as well, keep HBaic below 6.5, more towards 6.

And please give up smoking.....If you have a coronary problem, even though it is latent as in your case, smoking should NO LONGER BE AN ISSUE.

AFW's problem was much more serious than yours. You are considered latent, discovered because you were investigated. His was post infarct 5 years back with 'muscle loss' and pump dysfunction.

Cheer up and live life fully and of course, ' No korner baring please!'