FRAIL ELDERLY WITH DEEP CUT FORGOTTEN BY DOCTORS AT CGH

A BIG rant:
An 84-year old woman, weighing only 37kg, lies in the bed in a surgical garb the entire day. She has been in the ward since she was brought to Changi General Hospital in an ambulance on Tuesday noon after she blanked out and sustained a 20-cm horrific cut that went so deep you can see the muscle. Her frail skin, thinned by years of predisone, a steroid medication for her cushing’s disease, tore like paper, flapped over the bloody wound.

She was supposed to have a surgical procedure to clean the wound and patch her up that day, said the surgical team of doctors who came to see her and the wound that late afternoon. “But that depends on whether there will be more serious emergencies coming in, which will mean her less urgent case will be pushed aside,” said one. It was a refrain that was repeated and repeated with no end.

That was Tuesday, and now it is Thursday night. For 3 days, the poor weak woman stared as her roommates had their breakfasts, then lunches, then dinners and their little tea breaks. Her No Food, No Drinks label stared out behind her.

For the three days, while she waited for a flicker of hope of being wheeled out to the operating theatre, the doctors forgot she hadn’t ate. She was on a IV drip with the basic nutrients. That could work if that was a 35-year old woman or a 60-year old man or even a 70-year old woman – sharp, alert, and still strong. But it doesn’t work on a 84-year old woman, who is prone to short memory losses, who had been losing weight gradually over the last few months, and who had just been discharged from a separate hospital stay of over a week.

On Tuesday, when she was admitted, she was still alert and the doctor deemed her lucid enough to sign her own surgery consent paper. By the next day, drained of food, exhausted by the pain in her leg, another doctor found her not lucid enough to sign an anaesthetic consent form. On the third day, she insisted the nurses had moved her from another part of the room when she had not been moved at all. The nurses are wonderful. But communications from the doctors with patient’s family members and even among the doctors are woeful.

We had to check with the doctor every three hours to find out if she could eat. From Tuesday to Thursday night, she had only eaten one breakfast and one dinner. Close to midnight on Thursday night, hopes of a surgery had passed and the poor lady was then allowed to eat. At midnight – while others are fast asleep, she is eating. The only meal she has had in the last 27 hours.

Her physical state has been affected and so has her mental state. We spelt these out to every doctor we met – each a different doctor with the same story – the operating theatre is too busy with emergency cases. Tomorrow is a half day and all the OTs, except one, are closed. When will they consider her a serious emergency case then? When she’s lost all memory, when she becomes 30kg, when she forgets who we all are?

It seems the A&E operating theatre is in a total shambles. Each emergency that comes in, each day my mother in law gets kicked out. It questions the resources available at the hospital, it questions the competency and efficiency of judging what is serious. We can accept that life and death cases need priority on the first day, resign ourselves to it on the second day, get frustrated on the third day. As it moves into the fourth and very likely fifth and sixth day – who will hear us? The hospital’s administrator? The CEO? Or are they too tied up with the big picture that they forget that hospitals are, after all, for the little people in the end?

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