A Mother's Strong Back

No one has ever truly appreciated what I do as a doctor and how I do it. I am in Peri team almost two weeks already - everyone has to be in that rotation for a fortnight - and I am counting days to finish with it. Being in Peri means you are going to do a lot of walking (and running) from patient to patient, ward to ward, and inevitably, from building to building.

I am covering the Ortho cases from the medical female and isolated medical wards which consist of the entirety of the 7th floor. There are four of us hamba orang (HO) covering the whole hospital that includes Paeds, Surgical, ICU, etc. so we divided among ourselves on which wards to cover. There is a lot of pro and cons covering certain wards, for instance: Covering as a Peri Ortho in Surgical ward will give you very few patients to review but the cases are severe. That is because the patients who are treated under two departments such as Surgical and Orthopaedics very usually mean that the patient is of multiple trauma e.g. motor vehicle accident.

And for me covering the medical ward, the usual cases I see are the diabetic foot ulcer, pressure sores, and infection of the skin (cellulitis). The cases may be simpler and after a few days, become repetitive, but the number of cases that I have to review every day is simply stagnantly a lot and burdensome. 

And for that reason, coupled with being chewed and gnawed by my super scary specialist after not presenting cases properly during round (because I didn't have the time to review them all), I had to come early to work every day. Like, super early as in I start reviewing my first patient of the day at 4 am in the morning. That's how early I have to be. And in the hands of newly and fresh MO out of the oven, work became inefficient and as a result, I hardly be able to go back from home on time.

There's one patient I met in the medical ward that strongly reminded me of my late great-grandmother, Nenek Ik. I was notified that there is one patient to be admitted into female medical ward from the Red Zone Emergency Department. She was brought to the hospital the night before, and only late in the afternoon the next day she was stable enough to be transferred upstairs.


She was septic and her conscious level is deteriorating. We were referred by Medical team to have a look at the cause of her sepsis which is her back sore (sacral sore). For those of you who don't know what sacral sore is, you can try research for it from Mr Google or Grandpa Wiki. The way I usually explain to the patients and their relative is sacral sore happened to the person who was bed-bound for a long time. What happened then is that the body's gravitational weight put a pressure on the point of contact between the body and the mattress. Don't be shock - even though the mattress is soft and comfortable, the long contact pressure of your body onto it can cause a break in the skin (like melecet, or bergesel) and once the skin breaks, then the muscle, tendons, and even bone follow suits.

Skin is one of the vital organs of our body - it is waterproof and the first wall of defense from micro-organisms that cause infections from entering our body. Thus when the skin breaks, the layer of body tissues underneath it are prone to infections.


When I came to see the patients, one of her daughters was sitting in a plastic chair at the end of the bed. I was unsure whether she has been with her mother since last night or she just newly arrived to accompany her mother to the ward but nevertheless, seeing her mother's poor condition I had to retrieve the information from her instead. She has nine siblings, and she is the third eldest. Her mother previously lived with the 5th son for a few years but for reasons unclear then she lived with the 6th son for the past 5 months.


She claimed that her mother memang dah nyanyuk sejak enam tahun lepas and needed assistance for eating, bathing and etc. When I asked what exactly happened that led to the admission to the hospital, she said she didn't know much but the one who is taking care of her mentioned of her not being responsive and was rapidly losing consciousness. They straight away brought her to the hospital. When I asked about the wound at her back, she said she didn't know about it.


At this point, my mind went straight away towards Nenek Ik and the similar circumstances of her illness. My voice went strange as I fought the anger in my voice from leaking out. I had to put down my pen as not to show to her my hands that were actually shaking. I had already read the review the ED Ortho team put down. The wound was big, necrotic, emitted really foul smell with pus discharge and slough.


"Anak lelaki yang jaga mak tu, bila dah perasan ada luka kat belakang badan mak dia tak bawak pergi jumpa doktor ke?" I asked her.

"Tak, dia tak bawak pergi jumpa doktor," she replied.

"Kenapa ya tak bawak pergi jumpa?" my voice went a quarter octave higher.

"Saya memang taktahu doktor," while shaking her head slowly a few times.

"Dia ada bersihkan luka mak tak?"

"Ada."

"Berapa kerap dia bersihkan?"

"Tiap-tiap hari dia ada cuci, doktor."

"Habis tu kalau dia cuci setiap hari takkan dia takperasan bau busuk?"

"Dia perasan, doktor."

"Bila dia dah perasan bau busuk tu pun dia still tak bawak pergi jumpa doktor?"

"Saya memang taktahu, doktor. Saya tak jaga mak saya."


Right on cue, four more family member came to see their mother. I was unsure whether all of them are the patient's children, but if they were, then that made two sons and three daughters were present when I reviewed the patient.


"Ni ha yang lain boleh bantu doktor" - while speaking to the rest of them while retreating to make way for them to come forward - "...saya dah takboleh nak tolong. Doktor nak interrogate korang pulak."


They also gave similar answers to why nobody taking care of her pressure sore properly. The daughter then showed to them (and me) the wound she snapped from the ED downstairs. It was small, roughly the size of the thumb that was black (gangrene patch). From the picture I couldn't determine where the sore really is but I highly doubt that is the extent of her wound.


Then one of the sons asked me the reason for the mother's illness. While I explained to them about sacral sores again I asked about their mother when one of them held up a handphone and told me I could ask the one who was taking care of her directly.


And lo and behold, the exact same story he told me, now added with excuses. He mentioned that because he was busy with business (berniaga, not cooperation that kind of business), he didn't have time to bring her to see a doctor.

"Habis tu siapa yang cuci luka belakang mak?"

"Saya la, doktor"

"Macam mana encik cuci luka mak encik?"

"Saya lap kemudian saya cuci dressing luka dia tiap-tiap hari."

I had stopped listening to him. I was so fed up and I handed the phone back to whoever that gave it to me in the first place while the caller on the other end was still talking. I had enough. Then I spoke to them all.

"Saya dari bahagian doktor sakit tulang. Saya sini nak tengok luka belakang mak ni sebab luka ni yang menyebabkan mak jadi sakit macam ni sekali."

I added, "Oleh sebab tu, saya nak encik berdua (while pointing towards the sons) untuk tolong saya pusing badan mak supaya saya boleh tengok luka mak. Yang lain pun boleh tengok sendiri luka mak macam mana. Sambil tengok luka saya kena ambil gambar luka tu untuk memudahkan kerja doktor yang merawat."

So I pushed the bed a little bit so that I could stand on one side while the other two could stand on the other side. I instructed them to don on the gloves and taught them on where to put their hands for the turning. Then on my count of three, I asked them to turn their mother's body 90 degrees side way.


And the sight of the wound was horrifying.


The older son whimpered. "Ya Allah, Ya Allah.. Mak.. mak.."


Once I quickly snapped a picture for documentation, again on my count we carefully turned their mother back on her back. Then the crying began.


The son's legs gave in as he cried into his sister's shoulder. The sister had to support him halfway, herself crying upon witnessing the actual wound on their mother's back. I heard him repeating himself, "sampai hati buat mak macam ni. Sampai hati buat mak macam ni." I could only pat him gently over the shoulder as I gave them space to grieve. The younger daughter slumped against the wall, covering her mouth as she cried. The anger I felt initially burst away, filled suddenly with a profound pang of sadness. I was reminded of Nenek Ik, again, and how she, too, went down when no one had properly taken care of her.


I had nothing to say to them. Nothing left to say that could help them. I finished writing down the findings and I ended my clerking with a heavy heart. I felt disturbed at the sight of them all and there was a huge lump in my throat whenever I glanced at their direction. I went back from work later that day, hoping to write this all down but the sight of the wound, the patient's dying condition, and the reaction from them made me stopped halfway and thought of my own mother.


There is no way I will let that happen to Mama. There is no way Mama will be treated in the future, even when the memory and the body should fail her. There is no way I would let it happen.


May Allah granted all mothers the highest order of jannah, for they have carried all of us and the burdens of the world on their stong back, thus so truly the heavens lie at their feet.