I felt a cold silence. She didn't utter a word at first. But i was determined to break the ice, however thick it was.
She was one typical Chinese lady whom my senior pharmacist had counselled previously. I was told that the patient spoke very little Malay and English, and it was difficult to make her understand certain things. She just showed a lack of interest, perhaps it was plainly her indifferent attitude.
The vexing point was that - she had been tested HIV-positive, and the HIV team in the hospital thought that she would need to be started on HAART medications to prolong her survival. But of course, the team can't force her to start on these medications unless she was willing to participate.
HAART. It is the "Highly Active Anti-Retroviral Therapy". The phrase itself is a big jargon for most patients. In fact, this class of drugs is not like any other drugs you see in a pharmacy:- They are nothing like the normal oral antibiotics which you take for a week, and your infection resolves. They are nothing like the antihypertensives regimen, whereby you can skip a dose or two, and your blood pressure will still be okay. They are nothing like the over-the-counter Panadol, which you can just pop it into your mouth anytime you have a headache.
It is a combination of potent antiviral drugs to combat HIV infection. With HAART, it's completely a different challenge for the patient. One would be bound to the medications for a long time, perhaps a life time. He or she can't afford to miss many doses, otherwise the treatment would be deemed useless. Also, the patient must take the dose diligently at a fixed same time everyday. A dose fixed at 8am means it has to be consumed at 8am - no compromise. Not 7.30am, not even 8.30am. Adherence rate should ideally be near perfect, if not perfect. In simpler terms, out of 100 days, the patient can perhaps afford to miss a dose or two? This is to reduce the emergence of HIV strains which are resistant to treatment.
And, how was I suppose to tell all these to a 50-year old Chinese lady, everything in layman's term, in a language which she would comprehend? How do i make her understand that she would need the HAART therapy now? My senior stood aside and allowed me to carry out a conversation with the patient. It would be a very sensitive thing to talk about, but I just want to help this particular patient as much as I can.
Of course, her initial expression spoke of "Why do you people in the whitecoats, never stop bombarding me?". But after a while, she started to speak more and more. She started to open up. She told almost everything, how devastating it was when she was newly diagnosed. She refused to tell me how she got it, but i respected that. She had a daughter who knew about her condition, but she kept her status a secret from her other family members and friends. She had very limited educational background, and she found it very difficult to understand her condition. To accept the stark truth is already a nightmare, and now she was forced to learn to understand the whole thing.
Between her lines of words, it was the pair of eyes, the hopeful eyes in her, which told me an even more important thing - that she still loved herself very much. I held her hands in mine, and I told her, I was going to make her understand everything on that day itself, no matter how much time it would take.
I told her what HIV infection was all about. How it got into her body. How it was affecting her immune system cells. And I thought "immune system" would be too big a word for her, so i told her it is equivalent to our "body army". And why she needed the HAART medication as soon as possible to kill the virus, and to strengthen up her body army. It's like a war game. she needed the shield. the drug. to suppress and to combat the enemies. And she had no time to waste - the longer she chose to procrastinate, the weaker her army would become. the stronger her enemies in the body would be.
I paused. She looked overwhelmed, muttering some words. I could sense there was still something bothering her. I allowed a moment of silence, after which she finally asked,
"How much do I have to pay for all the medications?"
Looking straight into her eyes, i told her i have both, good and bad, news for her, "The bad news is that, the medications are going to be very expensive, depending on which type, some may be RM500/monthly, while others up to RM1000/monthly. But here's the good news, you'll be subsidised, as long as you promise to be compliant to your medications."
Little did she know that this is one of the most rewarding news i've ever broken to anyone else in my entire life. Her whole face lighted up with a faint smile. i could sense that half the burden on her shoulders were off down to the ground now.
Before I left, i quietly whispered to her, "Over here, we are all open to help you, but you would have to help yourself first". She nodded in agreement, and I felt a soft squeeze in her hand with a smile on her face. She was more a friend to me now than a patient. She was no longer the hostile-looking grumpy lady just a moment ago.
What we didnt know too was, at that time when i spoke to her, death was already very near her. Nobody knew, for she was still looking fine. Later on, she had a few other conditions which crept in. She was readmitted again, and this time she didnt make it through the first night of hospitalisation. When my senior broke the news to me over the phone, i just hanged up, biting my lips. I decided to trace her admission record from the office just to find out what happened just before death.
I learnt, sometimes things happen at the least expected time, in the least expected way. We just have to appreciate what we have today.
She was one typical Chinese lady whom my senior pharmacist had counselled previously. I was told that the patient spoke very little Malay and English, and it was difficult to make her understand certain things. She just showed a lack of interest, perhaps it was plainly her indifferent attitude.
The vexing point was that - she had been tested HIV-positive, and the HIV team in the hospital thought that she would need to be started on HAART medications to prolong her survival. But of course, the team can't force her to start on these medications unless she was willing to participate.
HAART. It is the "Highly Active Anti-Retroviral Therapy". The phrase itself is a big jargon for most patients. In fact, this class of drugs is not like any other drugs you see in a pharmacy:- They are nothing like the normal oral antibiotics which you take for a week, and your infection resolves. They are nothing like the antihypertensives regimen, whereby you can skip a dose or two, and your blood pressure will still be okay. They are nothing like the over-the-counter Panadol, which you can just pop it into your mouth anytime you have a headache.
It is a combination of potent antiviral drugs to combat HIV infection. With HAART, it's completely a different challenge for the patient. One would be bound to the medications for a long time, perhaps a life time. He or she can't afford to miss many doses, otherwise the treatment would be deemed useless. Also, the patient must take the dose diligently at a fixed same time everyday. A dose fixed at 8am means it has to be consumed at 8am - no compromise. Not 7.30am, not even 8.30am. Adherence rate should ideally be near perfect, if not perfect. In simpler terms, out of 100 days, the patient can perhaps afford to miss a dose or two? This is to reduce the emergence of HIV strains which are resistant to treatment.
And, how was I suppose to tell all these to a 50-year old Chinese lady, everything in layman's term, in a language which she would comprehend? How do i make her understand that she would need the HAART therapy now? My senior stood aside and allowed me to carry out a conversation with the patient. It would be a very sensitive thing to talk about, but I just want to help this particular patient as much as I can.
Of course, her initial expression spoke of "Why do you people in the whitecoats, never stop bombarding me?". But after a while, she started to speak more and more. She started to open up. She told almost everything, how devastating it was when she was newly diagnosed. She refused to tell me how she got it, but i respected that. She had a daughter who knew about her condition, but she kept her status a secret from her other family members and friends. She had very limited educational background, and she found it very difficult to understand her condition. To accept the stark truth is already a nightmare, and now she was forced to learn to understand the whole thing.
Between her lines of words, it was the pair of eyes, the hopeful eyes in her, which told me an even more important thing - that she still loved herself very much. I held her hands in mine, and I told her, I was going to make her understand everything on that day itself, no matter how much time it would take.
I told her what HIV infection was all about. How it got into her body. How it was affecting her immune system cells. And I thought "immune system" would be too big a word for her, so i told her it is equivalent to our "body army". And why she needed the HAART medication as soon as possible to kill the virus, and to strengthen up her body army. It's like a war game. she needed the shield. the drug. to suppress and to combat the enemies. And she had no time to waste - the longer she chose to procrastinate, the weaker her army would become. the stronger her enemies in the body would be.
I paused. She looked overwhelmed, muttering some words. I could sense there was still something bothering her. I allowed a moment of silence, after which she finally asked,
"How much do I have to pay for all the medications?"
Looking straight into her eyes, i told her i have both, good and bad, news for her, "The bad news is that, the medications are going to be very expensive, depending on which type, some may be RM500/monthly, while others up to RM1000/monthly. But here's the good news, you'll be subsidised, as long as you promise to be compliant to your medications."
Little did she know that this is one of the most rewarding news i've ever broken to anyone else in my entire life. Her whole face lighted up with a faint smile. i could sense that half the burden on her shoulders were off down to the ground now.
Before I left, i quietly whispered to her, "Over here, we are all open to help you, but you would have to help yourself first". She nodded in agreement, and I felt a soft squeeze in her hand with a smile on her face. She was more a friend to me now than a patient. She was no longer the hostile-looking grumpy lady just a moment ago.
* * *
What we didnt know too was, at that time when i spoke to her, death was already very near her. Nobody knew, for she was still looking fine. Later on, she had a few other conditions which crept in. She was readmitted again, and this time she didnt make it through the first night of hospitalisation. When my senior broke the news to me over the phone, i just hanged up, biting my lips. I decided to trace her admission record from the office just to find out what happened just before death.
I learnt, sometimes things happen at the least expected time, in the least expected way. We just have to appreciate what we have today.
5 comments:
Darling, you're an angel. It takes a lot to be working in a medical house. I do not think I'd have the gumption, let lone the emotional strength to deal with sickness and death.
Being the emotional person that I am, this entry made me cry.
U've been a star on a cloudy nite to the patient, im sure. Not many of us could do that; that basic human touch. If only she have met you earlier, she might have been better off. But there's always limitations to what we could do for our patients. There's always God's will in our line of work. So, dont be sadden by it, let it strengthen us to reach out to more...cheerios!
i don't know if you know this, but i'm always so proud of you..
i'm really sorry for her, but i'm glad my sister was the messenger who brought those tinges of Goodness to this lady.
thanks peeps, actually i'm really thankful that i have a great bunch of seniors, those from my field as well as the others. Learnt lots of skills and gained great depth of knowledge. And i'm looking forward to more.
hey gal..tat was a very touching post, nearly bring me to tears
:(..hopefully i can be half as great as u..im so proud of u!!*hugz*
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