2. Staring Death In The Face

It’s a walk that I’ve taken almost daily for close to two decades.
The short stretch from my block to the condo lobby usually takes me less than a minute.
But on Thursday 21 February 2013, the distance seemed interminable, fraught with uncertainty.

I’d woken up early that morning to iron my son’s uniform, but could only manage the collar before the room started spinning and breathing became difficult, despite two days of medical leave to recover from precisely those symptoms. I thought, maybe a little more rest would help? So I tried reading in bed until lunch prepared by my older boy—noodles with clams, because the shellfish is high in iron.

A tiny alarm bell had first started ringing in my head on Tuesday afternoon when I found myself struggling to walk from my company’s security turnstile to the Newsroom. But the breathlessness receded after I’d sat down. As my thighs were aching, I attributed the strain to a strenuous workout at the gym the day before. It wasn’t until close to 10pm that I experienced a second surge of lightheadedness. Called the corporate insurance hotline to find out which doctor opened late and made my way from my office to the nearby KK Hospital’s 24-hour Women’s Clinic. Had my blood tested and was told that my iron level was low at around 8, the ‘normal’ range being 12 and above. Was prescribed a jab which I didn’t question but found out later that it was progesterone, my first encounter with this hormone. It tones down heavy menses, which I’ve been fine with for years as there’s no pain involved, only periodic tiredness. What threw me offguard was the accompanying breathlessness this time round.

The fresh-faced doctor on duty said to return if I didn’t feel better. So at 4pm on Thursday when the dizziness didn’t abate, I thought I would visit the nearest GP to check if my condition was serious enough to warrant a return to the hospital. Remember the campaign urging people not to go to A&E unless it was a clear emergency? Talk about obedient citizens—that’s me!

Called for a cab, took the lift and made my way across the rectangle leading to the lobby. Instead of my usual easy strides, a snail’s pace was all that I could manage, carefully holding on to the side railing. Saw a young woman watching three little girls playing and crawled past them. Just before reaching the main entrance, the sky seemed to turn black.

SHUTDOWN!
Absence of air. Suspended in a vacuum.
The outside world fading into nothingness.

I think I need an ambulance. But how?
Can’t call out, no breath nor strength.
And let’s not alarm the kids.

Can’t collapse here.
The lobby’s just ahead.
But where are the guards?
Focus on moving forward. Panting.
Taxi’s turning into the driveway.
Take one step, then a second, and a third.
One more breath, followed by another, and another.

Snap decision – this is no time to stop at a GP clinic first.
“KK Hospital, please. Sorry, I need to lie down, can’t sit up.”
Travel via CTE. Exit Moulmein or Bukit Timah? The least of my concerns.
Reached. “Please drive past the cab stand. Go nearer to the Women’s Clinic.”
Driver: “I thought you were going to faint just now.”
Paid. Entrance not far ahead, maybe 15 steps?

Walk in. Reach out to press the queue button. Nurse at Registration rushes over, calls for a stretcher. (Observant of her. Well done!) Fall into it. Lie down. Close my eyes to stop the world from spinning. Wheeled to Observation, blood sample taken. Results are out and it’s time to see the doctor on duty—another young lady. “Your iron count has improved from two nights ago.” Iron tablets work fast—I’d just taken it twice. Inexplicably, she then says I can choose to go home or be warded. “But Doc, I’m still finding it hard to breathe.” (I’ve never felt like this before, outside of intense exercise!)

Remembering the massive effort it’d taken me just to get to the hospital, I knew I had to be admitted. And I didn’t want to alarm my sons with a possible middle-of-the-night emergency, especially as my older boy was in the midst of his final exams. A quick message home to reassure everyone that I’d be fine, that it was better to be right where the nurses could keep an eye on me.

Waiting for a room to be prepared, it appears that a senior doctor is consulted and the focus shifts from the heavy bleeding to my breathlessness. “Here’s your oxygen nasal cannula, and we’ll be giving you a pint of blood.” The next morning, it’s time for a scan of the womb. The cheerful technician from China starts chatting with me about her experience back home. Lying flat, I find that I’m breathing hard. Gasping.

“I can’t breathe. I Can’t Breathe!”
She rushes over, sits me up, rubs my back.
BLACKOUT

“What happened?”
Such a lot of hustle and bustle around me.
So many nurses. The perky lady telling them, “I was so scared!”
I’m wheeled to a ward. “What happened?”
Nurse: “You hyperventilated and fainted.”
A doctor comes to check, calls for an Electrocardiogram (ECG).
He consults another doc; she comes over.
“Do you feel any chest pains?”
No. Well, just a little pressure on my left. Right here.

“We think it has to do with the heart.”
“We’ve spoken to the specialists at SGH. We think we should send you there as they’re fully equipped to deal with this.” Sure, please go ahead.
Nurse: “Ready to go?” Yes. I have belongings in my room, can someone help to get them?
Nurse: “Okay, I’ll pack them and take them to the ambulance.”

My first ride on an ambulance, and hopefully my last.
A doctor and a nurse are onboard with me. “Are you feeling alright?” Yes, thank you. I have my oxygen supply and I can breathe. The journey is surprisingly long. I was thinking—KKH to SGH, get on the CTE, exit Outram, max 15 minutes. It felt like forever as we didn’t travel via the highway. Tired, but every trip comes to an end.

Time and place suspended. SGH A&E. I think.
The accompanying doctor hands me over to her counterpart. “Take care!” Thanks.
New faces, fresh rounds of questions. A couple of eager medical students on attachment come over.
“May we ask?” Sure. Everyone has to start somewhere and skills are honed through practice.
I can hear one of them making her verbal report to someone behind a curtain.

A portable X-ray machine is brought over. Chest scan.
Triumph-“Look, there. Now we know what we’re dealing with!”
Pulmonary Embolism. Blood clots blocking arteries in the lungs.
Hey, that’s exactly where I’d told the KKH doctors I felt mild pressure!

A composite of faces. A blur of voices.
Humour always helps to brighten grey skies 🙂
“You work in the Newsroom? Does that mean there’ll be no news tonight?”
I believe that quip was from Doctor Witty. He was communicative throughout my stay, keeping me informed, translating medical jargon to laymen terms, giving me useful tips, even sharing a story about his family. For a journalist, constant information gathering is inevitable, so he played an important role in helping me piece together a picture of what was going on. If I recall the faces correctly, Dr Witty is a Registrar. Found out later from my hospital handbook that Consultants and Registrars are “Specialists—doctors with postgraduate qualifications in particular fields of medicine. Resident/Medical Officer/House Officer are qualified doctors who assist the specialists and senior doctors in clinical work.”

Leading the team who managed my treatment was a Senior Consultant whom I shall call Doctor Charming—in a most professional way—earnest, caring and communicative. And he listened.
A sense of humour—never leave home without it! Age-old wisdom from the Bible, “A merry heart does good like a medicine, a joyful heart promotes healing; but a broken and depressed spirit dries up the bones and drains one’s strength” -(Proverbs 17:22 composite).

Together, Charming and Witty inspired confidence in me to trust them fully with immediate decisions on my health and life. I learnt from the nurses that even on their days off, the Cardiothoracic (Heart & Thorax/Chest) doctors would drop in to see their patients, and I experienced that myself. Commendable dedication indeed—going the extra mile. Kudos from thankful survivors like me! I’ve always found the term bedside manners to be somewhat quaint, but I am very appreciative indeed of the excellent level practised by the doctors, nurses and physiotherapists at SGH’s Cardiothoracic ICU and Ward 56 who attended to me. I’m thankful too for doctors and staff from Interventional Radiology—read more about them in “Angels In The Operating Theatre!” as well as assorted healthcare personnel from various departments. (If my docs were to give me the go-ahead, I would gladly name them!) From my perspective, all of them partnered with God to walk me through from potential death to restored health.

Looking back, I can see clearly that it’s a miracle I didn’t end up with what one doctor described as a fatal “lung attack” masquerading as a heart attack. He shared that when people suddenly collapse, those with them typically blame it on a heart problem, but the root cause often lies in the lungs, and sometimes the truth only surfaces after a post-mortem is carried out.

God declares through the Bible, His inspired eternal Word, “For the eyes of the LORD run to and fro throughout the whole earth, to show Himself strong on behalf of those whose heart is loyal to Him.” (2 Chronicles 16:9). We’re also told that, “Are not the angels all ministering spirits sent out in the service of God for the assistance of those who are to inherit salvation?” (Hebrews 1:14).

I know that my God watches every step I take because I am His precious child, and He sent His angels to protect and sustain me so that I could receive the needed medical treatment. He’s stated many times in the Bible that “I will never leave you nor forsake you” so I felt an underlying peace and assurance, for after all, what was the worst case scenario—death?

I stand ready to meet my loving Heavenly Father and be received by Him into a secure eternity beyond earthbound limits. My days are safe in His hands, and while He keeps me in this world, I live to obey what He’s called good—”to do what is just, to show constant love, and to live in humble fellowship with our God.”

“Yes, though I walk through the [deep, sunless] valley of the shadow of death, I will fear or dread no evil, for You are with me; Your rod [to protect] and Your staff [to guide], they comfort me.” – Psalm 23:4
Jesus said, ” The sheep that are My own hear and are listening to My voice; and I know them, and they follow Me.” – John 10:27

My Hope Is In You – Aaron Shust
Lyrics/Music: April Geesbreght, Russell Mauldin

I Will Lift My Eyes – Bebo Norman
Lyrics/Music: Bebo Norman, Jason Ingram

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I’ve always had a very high pain threshold. And when it comes to injections, I’ve been the bane of nurses since primary school as I prefer to see exactly what they’re doing to me instead of looking away as instructed! I believe that if we look fear in the eye, it won’t be able to loom larger than life. But by the final week of my hospital stay, I’d been pricked so many times day and night by needles of assorted sizes that I looked forward to an end to multiple daily jabs! And my unvoiced wish was granted when Dr Charming ensured that. By the time I left the hospital, all I needed was oral medication—iron supplements and Warfarin (anticoagulant to “thin” the blood).

Warfarin is effective in preventing the formation (thrombosis) and migration (embolism) of blood clots but it was first developed as a pesticide to kill rodents! I’m taking 6mg daily, with regular blood testing to ensure I stay within my targetted INR (International Normalised Ratio) of 2-3. A pharmacist and a dietitian instructed me to avoid injury and cuts in case of excessive bleeding, and to be watchful of my Vitamin K intake. This relatively obscure vitamin helps blood to clot, and bingeing on foods rich in it would affect Warfarin’s efficacy. It’s interesting that the greener the vegetable, such as spinach and broccoli, the higher the Vitamin K content, as it’s directly involved in photosynthesis. So as Dr Chatty helpfully simplified for me, “Some people find it easier to remember not to indulge in anything that once had leaves.” 🙂

I was advised to apply for a Medik Awas (warning/caution in Malay) identification card which alerts emergency personnel to the carrier’s specific medication, condition or allergies. Here’s a useful piece of info: The next time you see paramedics looking through wallets or handbags at an accident site, they’re likely to be checking for Medik Awas devices rather than making sure the person can afford to pay for the ambulance ride! I’ve applied for a card as well as a metal tag that can be quickly spotted, and am waiting for the Singapore Medical Association to send it. When I researched this on the internet, I was amazed and amused that one woman complained about how ugly the plain silver tag was—does the look really matter as long as it serves its purpose?

Medical Terms that entered my daily consciousness:
Arterial Line (Art-line or A-line) – a thin catheter inserted into an artery, commonly used in intensive care medicine and anesthesia to monitor blood pressure real-time and to obtain samples for arterial blood gas measurements.
I recall a tap-like top piece that was turned on and off, making me feel like like a mini bloodbank!
Oxygen Saturation – a measure of how much oxygen the blood’s carrying as a percentage of the max it could carry. Oxygen molecules travel from the air into the blood and is oxgenated in the lungs.

Legend
CTE: Central Expressway
A&E: Accident & Emergency
SGH: Singapore General Hospital
KKH: KK Women’s and Children’s Hospital

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