Saturday, May 16, 2009

tolonglah maafkan saya

there have been several memorable patients during my first year of clinical school. there's the humorous elderly malay gentleman who is a treasure chest of cardiovascular signs. there's also the young police officer who became paralysed waist down after an unfortunate accident on his 23rd birthday.

but none delivered a more shocking revelation than this one bangladeshi man i met during my electives last month.

he was involved in an accident and brought into the emergency department. he was conscious at the time and appeared stable. however, a pneumothorax was suspected and he was wheeled into the resuscitation zone not long after.

once there, the team whipped into action, inserting more intravenous access lines and monitoring his vital signs closely. they put an oxygen mask onto his face, drew blood for investigations, sent him for an xray, gave him some drugs and waited for the surgical folks to arrive.

at some point he started becoming restless and attempted to pull the mask off. he swatted at anyone who came near him and got the lines all tangled up. some medical assistants restrained him and tried to calm him down by explaining why they were doing what they were doing. we're helping you, they said, just let us help you.

eventually he stopped struggling and started to apologise. maafkan saya. maafkan saya. maafkan saya. over and over and over and over.

the staff were puzzled. why are you apologising, they asked. you didn't do anything wrong. but he kept expressing how sorry he was. maafkan sayalah. tolong.

it went on through the insertion of the chest tube that released not just air but also blood around his lungs. he whimpered in pain as the team cleaned up and sutured the last of his wounds. as they prepped him for admission, they continued to assure him that he wasn't at fault, that he wasn't to blame for what happened to him. still he kept apologising.

it wasn't until much later that i realised the reason behind his remorse. he didn't understand what was going on. it didn't occur to him that he was being treated for injuries that he sustained when his motorcycle skidded on the highway. all the needles, stitches, tubes, monitors...

...he thought he was being punished for some wrongdoing only known to himself. he saw it all as a form of torture for his sins. so he repented. apologised. hoped for it to end. maafkan saya. tolonglah maafkan saya.

i'm not sure why this incident left such a deep impression on me. i don't even know what exactly i'm supposed to learn from it.

did the staff treat him appropriately? i think they were pretty fair in terms of caring for him. were they rude? no. did they do anything to him that implied torture? not that i can recall. was there a language barrier? perhaps. was there any discrimination because of his status as a non-malaysian? not really. did he deserve to feel punished? tortured? of course not.

so what could have been done differently? what did they do to incite such guilt?

maybe the reason i remember it so well is because i am meant to ask those questions as an attempt to empathise with the man. perhaps i will find those answers later in my practice. for now, though, he will be among the most memorable patients i've encountered.

lishun at 3:35 PM