**This post took legit 3 months to type.. I think i subconsciously didn't want to relive the memory but oh well.. sorry if the timeline seemed really spread out.
2 posts per year, that's pretty much the most you are probably going to get out of me at this point lol. Also just a side note, this is the first blog post that I am typing from my mechanical keyboard which is 4 months plus old hehe. Currently using the Royal Kludge s98 Bluetooth mechanical keyboard. I have opted for the brown switch because I was using Von's old keyboard which was a blue key board and it was very clickity clackity, so decided to tone it down abit, but not too linear like the red key (which honestly after typing on this for 4 months, I might opt for a red key next).
Anywayyy Its been pretty much half a year since my last update. Safe to say alot of things have changed. But sadly not really from my side, but my family side and how much it has changed everyone's lives mainly my mum and my sister who are constantly at home. Back in April, my dad was admitted to SJMC at first due to having a heart condition which, to be honest, until today I'm not sure if it was a STEMI or NSTEMI, cause obviously no one tells me these kind of things, and is hard to actually talk to any doctors when I'm like almost 1000km away. So yeah, he decided to go for a mini CABG after noting he had a multiple blocks on vessels, which I can't remember which ones it was. Of course, there is the conventional CABG where the surgeon cracks your ribs open and worked on the heart directly there. Then, can't remember which doctor decided to introduce my dad to a relatively new procedure in Malaysia with minimally invasive CABG, in which it was done pretty much laparoscopically per se? Which honestly was kinda cool. Obviously, my dad was keen on that as it was cosmetically better and technically faster healing.
He went through the operation under Dr Syafiq at KPJ Damansara. (who surprisingly out of all coincidences, turns out to be Far's cousin like, are u kidding me). Recovery was okay, he was still able to walk after that which is when I went to visit him in May when I headed back to Selangor. Then as I was picking something off the floor while he was sitting, i noted his right 5th toe was completely gangrenous. Obviously, my dad didn't tell anyone that he stubbed/hurt his toe like 2 weeks plus ago thinking it would heal on its own. Dad being stubborn as he is, clearly ignored my pleas for him to visit the doctor. The toe was still at a dry gangrene stage at that point, so I wasn't worried about infectious per se, and I hoped for an auto amputation but that was me being optimistic. Needless to say after I went back to Sarawak, his toe became wet and it started to hurt.
Thinking that he just needed a simple Ray's amputation, I suggested PPUM as the treatment centre as my dad had dialysis and will need nephro support as well AKA private bills rack up real fast. Using my GL it would save a lot of money. Needless to say, the ED trip was on the slow side because which government hospital isn't overwhelmed as balls. However my dad in the end was diagnosed with acute limb ischaemia, and was admitted under vascular instead of ortho. Just so happened Sui Weng was part of vascular team then, and he helped update regarding my dad's condition from time to time. They did an angioplasty and managed to clear and restore most of the blood flow. Inevitably, my dad went through 4th and 5th digit amputation which started the nightmare. The bone culture ultimately grew like 4 bacterias which were resistant to alot of shit. So stayed on in UM for like 2 weeks of antibiotics, and put on vacuum dressing and sent home with vacuum dressing as well.
The foot wound actually healed quite well, but obviously, these few months have been quite tough on my dad and mum. Dad looked so much older and frail, but the attitude was still there hahaha, which my mum and sister were pretty much done with. Getting him to and fro dialysis was abit difficult but not impossible yet. Technically he could still walk, but pain control was an issue for him as he couldn't tolerate alot of conventional pain medications as he would vomit easily. So there was a challenge. When I was back noted, the shin part started to have cellulitc changes as well, I did ask my dad if he wanted to go to the doctor earlier than his appointment, but he was keen to sit and watch it out. Hence we had to let it brew again. Sure enough, next appointment he was directly admitted from the clinic itself, which was good in a way because he could skip the entire Emergency Department ordeal. But soon, 3rd toe was amputated as well, and another angioplasty was done to see the flow, which according to the vascular team was still good. The reason the wound on top was not healing well despite multiple debridements was due to the infective changes.
Before I go further on the wound not healing, as usual OT slots are hard to come by in the hospital. My dad being ESRF paitent with DM, technically should have been a priority case, but due to the infective (dirty) classification, his case was being pushed back as well. So comes an issue where my dad was fasted for a long period of time without IVD mind you (due to his ESRF status), which should have allowed him at least 1 pint maintenance for the day, but somehow that wasn't given. Fast, OT no slot, refast again. Dad had multiple hypoglycaemic times as well, which shoot D50 and thats it. Like the fluctuations of sugar is obviously not good for the brain. I dunno multiple times I questioned my dad's care plan from the vascular team which was pretty annoying.
Ok, back to the infective issue - osteomyelitis we call it. That part was causing the wound to not heal properly on the shin. So there was this long drawn-out discussion if a BKA was needed or not. Until the last debridement by the vascular team done at night, where they claim nothing much of debridement could be done anymore at that point due to it being so thin already, and the next layer would be tendon and bone. Right after that last debridement, my dad suddenly started having delirium. Like super acute onset, right after the operation. UM team blamed it on sepsis as my dad's septic markers were slowly increasing, but the whole event made me think is there a direct causal effect, like it happened RIGHT after the operation. Post sedation psychosis? Hypoglycaemia too much until there was some sort of cerebral oedema? I don't know. Took them lika a week before they decided to do a CT brain (which was upon my request through my mother) only they decided to do it. Fine, CT brain was pretty much clear, so no organic issues there per se, but still the speed of them doing stuff. Like my dad complaining of SOB / chest pain, sure vitals were OK, but at least do an ECG? Nope. Tried calling vascular oncall, unreachable. Whats the point of being oncall if ur unreachable? Dumb. So dumb. Definitely one part of me regretted sending him to UM. For the nurses, some are very good, but most of them makes you feel like you are talking to the wall when you talk to them. It's so frustrating to be honest.
Then now because of this delirium issue, I had to take some short emergency leaves and shift some oncalls to fly back to see my dad and have a family discussion with the vascular team. It was so short notice hence I had to buy some expensive tickets around 500 plus, flying the first time to Subang from Kuching which was definitely fun. Then, parked at ChongLin, no maxim, no grab to pick me up to the airport. Panicked and drove myself to the airport. Had to park at the airport. It was either that or risk missing my flight. Sure enough the parking cost me RM96 in the end LOL, and cash only which sucked so much. Anyway, seeing my dad being confused and delirious like that, yeah it hurt. Not gonna lie, I thought I was pretty much dead inside, but I realized most of the time I just wall off feelings and shove them inside. I mean definitely, I am more heartless now compared to when I was much younger, but yeah still a soft spot for my parents always. Was pretty quiet after visiting my dad for the first time, even my sister noticed it.
My dad was really not keen on doing a BKA, as he felt like he was being rushed into the decision. This was what we could get out of him in like that few minutes of sanity. If not he would be plucking things off the air, talking to non existent people and passing random objects to us to throw.. But then geri psych came and assessed him as well and deemed him not fit to making consent, so in the end we had to proceed with the decision for BKA for him, and I took reigns and proceeded with it, cause it was a life saving procedure so u know, life before limb. However, the BKA could only be carried out after I have left back to Simunjan which is a giant pity tbh. So I followed up on my dad (thinking back it wasn't as much as I should have. Guess another one of life's biggest guilts.
Long story short, he did improve by a lot after the BKA in which means that big bulk of the source has already been cleared, partially due to the psychological blockade of whether he should or shouldn't do the BKA. So there's the thing. But the wound wasn't healing very well, and again it was another talk of do we continue with the dressing or go higher up to do an AKA. At that point I left it up to my dad cause apparently when he was abit delusional, he would say that my mum was the one who made him do it, cause she was the one who signed the consent form for the BKA, hence it was really traumatizing for my mum to go through as well. Me, being from the medical field naturally didn't care that much about it cause I knew that he didn't mean it. Of course, it was harder for my mum who literally stayed at the hospital for months just to take care of my dad.
I think another month passed and then my dad was starting to not do so well anymore. His psych kinda went downhill again and I mean he is homesick. He wants to go home but the antibiotics and all its just hard for him to go home... Plus the logistics of it, like I wasn't home so it was hard for anyone to carry him around seeing that u know, he is an amputee now. Its difficult. Sure the regret is there really not to bring him home now retrospectively, my dad hasn't been home for the past 4 months... Meanwhile I was kinda enjoying myself here and there in Sarawak... Not a great son.. A lot of things I could have done more to be honest and it's another one of those regrets that will likely stay with me for a very long, long, time.
So yeah, my dad basically deteriorated in condition and had to warrant for an ICU admission. Luckily he was attended by my friend Wong who just so happened to be oncall that night. He messaged me and updated me the condition of my dad and did prep me to come back soon. Which I tried to come back ASAP. By the time I actually got back my dad was already transferred to ICU, basically thinking his condition was bad and that time was already on CPAP/BiPAP I can't rmb clearly now and he was pretty drowsy. So many family conferences, with vascular, with ICU team, sadly now I can't really remember the Prof's names but oh well.. Guess it didn't really matter in the end. The Anaes MOs were pretty helpful and in the end we decided to continue with one last-ditch effort with elective intubation. Then somehow it came to a point where did we want to proceed with AKA as well, since my dad was intubated and his condition was somewhat stabilizing... In the end is all about source control, and i mean his CRP was all improving but the wound was still not healing.. Same thing again, trying to get an answer out of my dad was near impossible. Although he did signal to my mum before this that he was done already.. but it was never really conclusive and it was really really difficult for us to make a decision. Do at least got better chance of survival I felt... So I opted for the AKA since pain management would be better since he was intubated.
Until today I still don't know if that was the correct decision, the only way to know is ask my dad myself when I die.. that is if there is something after we die.. and not like reincarnation or just more hell and suffering.. I don't know anymore lol.. Yeah but after that I had to fly back to Simunjan after making the decision for the AKA.. Not long after the anaest MO called me again to update me and recommended that I head back.. That was pretty much the final week that I had to go back.. Family conference for the DIL/NAR status after extubation.. then dad wasn't strong enough to expel all the sputum from his lungs.. It was really sad... Imagine drowning in all that thick mucus and you just don't have the power to expel it... Then added on he had a DIVC episode, difficult vascular access for his HD that required IR intervention x2... Like.. dear lord he suffered alot near the end... After a week, dad finally transferred out to a normal ward, in which we were referred to palliative dr as well.
Dad only stayed in the normal surgical ward for one night... Then slowly could see he wasn't doing well... Wish we could get that εε θΏη § moment that I saw when I'm working... but sadly that wasn't meant to be cause my dad's GCS was just so poor... Lastly the MO called us while we were driving to the hospital that my dad was critically ill.. hence sped to UM and dropped my mum first before I headed up to the ward.. Called my sisters and asked them to get here ASAP... It was hard cause they were coming from different parts of KL altogether so it was rushed. My mum and I were lucky to be there when my dad's heart finally stopped, which my 2nd sis just barely missed and my eldest sis missed it cause the jam timing was just bad. I don't know if it was lucky or not.. Wong was the one that was oncall that night as well to pronounce my dad's death... So it was his name on the burial permit which I guess helps? I don't know.. At that moment definitely sad, but I held it together, because I was really really finally relieved for my dad that he was done. Done with life and done with all the sufferings. Just sad that he didn't get to enjoy the life that he wanted after working so hard for us and he didn't even get to properly enjoy. Sure we are a family with many flaws but I still love my dad with all my dear heart. Retrospectively I definitely could have done more as a son while my dad spent like a good 3 months in the hospital.. Sending him to PPUM might be my biggest regret. End of point. Not going to elaborate further on that but I feel guilty. Guilty as charged.
Dad if ur still reading my blog, or if you actually knew that I have a blog... I love you. I'm sorry that I wasn't a great son leading up to the ultimate end. I know ur happy to see me whenever I came back to visit and I'm sorry when I go home to visit it's always not in the best of circumstances. I'm sorry I didn't call back as much as I could instead of lazing around in my room in Simunjan. I'm sorry that I didn't think on the best interests of ur health on certain decisions. I'm sorry I made the call to proceed with the BKA, and AKAs even though I don't really know if those were your wishes or not. I'm sorry that I may not be able to become a specialist as you wished I could. I'm just sorry that in the end it turned out this way and I wished I could do so much more to help with all the pain and suffering you went through. I will always love you, always and forever and you will be the great dad that lifted me through my education even when you had so little education yourself. You're amazing and I really hope you are enjoying yourself now that you can't feel anymore pain. Love you till forever daddy. <3
No comments:
Post a Comment