Monday, 12 September 2011

Easy money for the orthopaedic surgeon




                                            Caricature of a sick man

Dr Zhou tapped on the paper notes laid bare in front of him on his desk with his pen repeatedly, as he went through the medical diagnosis, blood test results, electronic cardiac graphs, CT scan reports and other details of the profile of the patient. “Hmmm….there’s some monies there!” He soliloquized softly as all present in his consultation room waited gingerly to listen to him. A middle-aged man, Dr Zhou was the senior consultant orthopaedic surgeon of a famed private hospital in down south Johore of Malaysian Peninsula. He took a quick and cold glance across his consultation room to study all the faces he met. They were all Singaporeans; the critically ill patient was a former Malaysian alright. His family sought treatment for this aged person as it was very much cheaper in Johore than having treatment and surgery in the affluent state neighbour.

              Blood sugar index reading for this little Shanghai girl

Dr Zhou cleared his throat and began his swift and blunt announcement to all present: “Yap Phan Loy, businessman-importer of dried marine products and sea food; aged 65, blood group B+, weight 110 lbs, heart beat 120 per minute, too fast for a healthy person; your stomach is bloated and that indicated liver failure to some degree, your eyes are yellowish and you’re blind with your left eye. The color of your urine sample is blurry brown with unfiltered impurities. You’ve dialysis three times a week due to kidney failure and you’re critically diabetic Type 2; three pulmonary arteries of your heart are blocked 70 to 90%, and you have breathing trouble since your lungs are blackened, no thanks to half century of heavy smoking.” Dr Zhou paused to have a sip of water before continuing, “despite that you have low blood pressure of 90/60 and that means you could slip into comatose or just black out anytime. “Mr. Yap”, Dr Zhou held the patient’s left wrist as he studied the multiple needle marks present near the joint of the elbow, “your sickness is very worrisome.”

                 
                         Have you got to go to extreme                  
                                   to do the amputation, Doc?

“Yeah I know. My time is up…..” came the weakened, almost inaudible reply of patient Yap. “I was a hefty 160 lb this time last year and I was still drinking whisky at least once every week, until my wife stopped me.” 
“This old man, never wanted to listen to me and never follow doctor’s instruction!” exclaimed Mrs. Yap, a woman in her late 50s. “We only knew that he was gravely ill when his friends brought him back unconscious with wet pants after a heavy drinking spree.” She was more than happy to review what had happened.

      What shall we do next?

“Dr Zhou, will my father get better, eventually be cured and fully recovered?” A man in his 20s asked sheepishly as he sat next to his sister who looked slightly younger and who actually was sobbing quietly.

“Not very likely, young man! As according to Dr Yang” Dr Zhou answered curtly. He picked up the diagnostic report from the hospital’s leading physician, well known nephrologists Dr Yang. “In fact your father is dying! He couldn’t be around you folks too long!”, “Look at the severity of this gangrene on his left foot; the toes are very badly infected, and they have turned black!” Dr Zhou’s blatant reply seemed so tactless and unfriendly. “Dr Yang referred you to me as I am an orthopaedic surgeon to amputate your left foot from the knee below so as to prolong your life further.” He turned to senior Yap but avoided his eye contact. Dr Zhou remained very intimidating in his voice as he searched for the right part on the foot where he could slice the first incision.


“For how long?” the frail old Yap asked.
“If your left foot remained with you, you can only live through this month. Dr Yang had made himself very clear on this.” “With you foot amputated, perhaps you can live for another six months.”
“I don’t want to die minus one foot. I want to die with my body intact.”
said the gravely sick patient, with a soft but determined tone.
“I know how you feel but that’s the only way.” Dr Zhou stood up and gestured all present to follow him to his study room, leaving the poor haggard dying man behind alone on a cold metal sick bed. He softened his arrogant way of speaking and turned friendly to the family of the patient. “There’s a way out, I’ll explain to all of you now. As a surgeon I have to look into all ways to make my patient comfortable and have his wishes met even his is a terminal case. Of course the family members’ concerns are equally important, like trying to prolong loved one’s life; thus the financial aspect must be brought into the pictures too.”

                           
                                 
“Money is not a problem!” chirped Mrs. Yap who had not been very patient with the surgeon’s idiosyncrasy. “Glad you said that.” Dr Zhou suddenly became a perfectly articulate gentleman in explaining all details to the earnest people gathered around him. “The amputation must be carried out. The hospital will keep the severed limb of the patient in a frozen store room which is part of our medical research facility. All of you shall feel free to ‘visit’ or to view the amputated foot any day you want, during office hours of course.” Dr Zhou winked suddenly with a mischievous smile. “Allow me to continue: when the final day comes, Mr. Yap’s body must be brought to my operation theatre and I will re-attach his severed foot to his body so that he can have a full body ready for the funeral.”

                        Young people got a misconception
                                       of smoking and boozing.
                                  There's nothing classy about it.
                                        It's suicidal at early age

“That’s quite a compromising idea but it is a good one.” The younger Yap nodded and stared at his mother for agreement and approval. The mother agreed readily, hugging the younger child, her daughter who was in tears. An amount of cost for the whole process was discussed further and agreed upon by both the patient’s family and Dr Zhou. 50% of the total cost was to be settled at the discharge of the patient after the amputation.

Shortly after Mr. Yap’s amputation of his left foot, he became jovial again and was generally healthy except he still got to have his dialysis done three times a week. The family enjoyed some peace as the senior Yap did not complain or yell at them any more for discomfort or nagging pain. But things took a fateful twist just after the 5th month of his surgery; suddenly Senior Yap’s health took a nose dive. He could not swallow any food or drink, he had trouble breathing, and his heart beat shot up to 210 per minute before descending to a faint, weak pulse. An initial examination with the physician revealed that most of his internal organs were not functioning. Less than 24 hours later, Mr. Yap had an awful GIB (general internal bleeding) and was subsequently declared dead.
                             
                       Candle burns to mark a passing life

After a certificate of death was issued by the hospital's administration office, Mr. Yap’s body was wheeled into the O.T. of Dr Zhou, the orthopaedic surgeon. The amputated left foot was home at last; it was re-attached to the deceased’s body where it was detached by amputation. The Yap family held a grand funeral for the passing of their beloved father and husband. They thought that the hassle of it all they had gone through to make their father happier before his death was well worth it. At the end of the funeral they chose cremation for Mr. Yap’s final rites.

              It's not surprising to know that parents strive so hard
                             to send their children to medical colleges
                                       
Dr Zhou stared at the check he collected from Mrs. Yap, it was the 2nd 50% payment due to him. This time it was for the re-attachment of the amputated limb to the corpse. He chuckled with a bit of frown, and whispered to himself: There’s money in it alright, it’s easy money. I should have charged $150,000 instead of $100,000!

A real story I heard
Alan CY Kok           

For those who may be interested:
This book is essential for Nursing Students and practising Surgical Nurses:
http://lpntobsnonline.org/2011/25-essential-reference-books-every-surgical-nurse-should-own/ .




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