Fragility

"Life is not measured by the number of breaths we take, but by the moments that take our breaths away"

While doing a 2-week relief term in the Haematology unit at a local hospital, I was asked by a friendly dietician whether there was any difference at all between managing the patients here compared to the ones in my homeland. Her concern was whether it would have been better back home, given our more sophisticated setups and state-of-the-art compounds in comparison to the tattered building and image of the old Mater Hospital. My reply to her was simply: "No difference".

Firstly, I feel that the principles of management would have been of the same wavelength at both places and probably worldwide, at least in developed countries. How far can we deviate from the basics as long as the medications and potent drugs are available and of similar generics? With the advent of evidence-based medicine, it is of paramount importance that we follow the recognised practice code and not indulge in unorthodox treatments which may be more detrimental to the health of the patients.

"Does Mrs Davis, an elderly 89 year old lady with erythroleukoblastic picture in her blood film, require a bone marrow trephine and aspirate....?"

"Jane is a 32 year old mother of two with a newly diagnosed ALL (acute lymphocytic leukaemia); she would require prophylactic intrathecal chemotherapy during the course of her treatment...."

Although my last 6-month rotation in Haematology was 2 years ago, I could still remember the chemotherapy regimes and procedures with ease and familiarity. We treated the dreaded neutropenic sepsis with anticipation and aggression, subjecting the patients to high-end antibiotics and fungal treatments. We loaded them with bags and litres of blood and platelets to restore the deceptive glow on their cheeks while halting their epistaxis or bleeding guts. We collected CSF (cerebrospinal fluid) for analysis before infusing the highly potent cytarabine and prayed hard that the merciless disease had not infiltrated the nervous system.

I have met the most compassionate and dedicated physicians during my rotation here and back home. I remember with fondness the gentle teachings and comforting words articulated by our head of department in one of the largest transplant centres in my homeland, a very soft-spoken and humble gentleman of high standing and great accomplishment, who eventually set up the first stem-cell hospital in my country. I remember the high-morale battles we fought together and the sadness when our longtime patients lost theirs. My seniors were kind and extremely knowledgeable, and through their expert guidance, I have mastered the proper skills of performing the essential bone marrow trephines, administering intrathecal agents and conducting clinic sessions with confidence.

I noticed similar traits in the attendings (consultants) here and admired their excellence in knowledge, professionalism and empathy. It was regretful that I would only be with the department for a mere 2 weeks before flying off for my annual leave.

The patients left the most indellible impressions during these rotations. Being inflicted by these long-course illnesses, they would have to make several trips to the hospitals for the treatments and the complications that ensued subsequently. They were of varying ages and backgrounds, with differing prior fitness and medical histories. The commonest question on the initial learning of their diseases would always be: "How did this happen? Why me?" It would be a million-dollar answer to conquest.

Regardless of their origins, whether they were Aussies or Asians, they had similar optimisms and tenacity. With supportive families and friends, they valiantly braved the pains, nauseating moments, hair loss and increasing fatigue. They turned paler by the day and lost their chubbiness or pot bellies. They sighed with resignation at the fragility of life and made resolutions of what they wished to attain before their last moments. The pictures of their loved ones on the walls and the bibles on their tables became their sources of inspiration and will-power. It was uplifting when some of them eventually made their strides into the clinics after their victories, but depressing and demoralising when they finally succumbed.

"Death is not the greatest loss in life; the greatest loss is what dies inside us while we live" (Norman Cousins, American essayist and editor, 1912-1990)

Hopefully it was with peace of mind that they breathed their last, and that all those around them who were involved in their care would seek eventual closure.