Getting the Pulse Back

Sandra Wainwright, MD
Sandra Wainwright, MD

Today I learned that the pulmonary department is the highest volume and acuity department at Cho Ray Hospital. It averages 150 patients in a 60-bed ward. I will admit that when I walked up to the 8th floor, I was excited to see patients filling the hallway. Room after room was full to double the capacity with patients and their family members doing PT, changing linens, feeding, cleaning, and cooling their loved ones with hand held paper fans, using locally-bought ensure tube feeds, administering medications they bought from the pharmacy, bagging their loved ones because there aren’t enough mechanical ventilators. I was told by the doctors that there are professional “baggers,” people who offer their services to bag the patients for two dollars an hour. Many of them make more than a typical doctors salary at the hospital.

The X-rays are impressive, and tuberculosis and malignancy are on every differential diagnosis.  Patients have little to no exposure to healthcare, so by the time they need medical attention they are severely ill with no past medical history because they have never seen a physician.  It is like working up a patient from scratch every time with only lab tests to help figure out what their underlying comorbidities must be. The patients are so kind, happy, and generous in spirit despite most having terminal liver disease, lung disease, kidney disease or malignancy. Regardless of the cause, if a patient has a pleural effusion, he or she is admitted to the pulmonary department and, like in the United States, the pulmonologists treat them holistically, looking beyond their organ system for treatment.

There is little time for doctors to explain what is going on to patients’ families, and a respectful barrier of politeness causes families to sometimes be too timid to approach the doctor. The other morning, a patient who looked like a teenager but was really much older was extremely jaundiced and began to develop respiratory failure and coded. I happened to be nearby and and began CPR while the nurses grabbed their medical carts and the resident began to intubate the patient. We were able to get the pulse back.

I was moved to tears when no sooner had I prepared to leave the bedside once the patient stable when his relative embraced and thanked me. Other family members just wanted to touch me because they were so grateful. In the ten minutes it took to get the patient’s heart back, they had gone to a store and purchased a case of gifts for me. I tried to refuse because they have so few resources, but they were persistent. I had to go to the bathing area the department provides for patients and family members on the ward to weep in private. Fortunately it is so hot and moist here that maybe they could not tell if I was crying or just overwhelmed by the heat. Later that afternoon, families of other patients reached out to touch me and thank me for my help.

Everyone is in such a desperate situation, yet they put others ahead of their own needs. The Vietnamese people call each other brother, sister uncle, aunt, child.  They are like an extended family and treat each other with such regard. Late that day he coded again. We brought him back but his family knew he was dying so they requested to bring him home so his spirit would not become a wandering lost ghost stuck at the hospital for an eternity.  No sooner had we finished coding this jaundiced patient that the neighboring patient also arrested. We performed CPR on him too, and he was quite hypotensive.

The doctors here are so overworked and underpaid, yet seem to find composure, compassion, and family life balance in the midst of their chaotic lives. It is true that the Vietnamese people are the happiest on the planet. They open up and smile easily once you break the ice and say hello.

I am so grateful for this opportunity of a lifetime. I am unsure if I made any impact on Cho Ray, but Cho Ray has left an indelible mark in my precious bank of memories.

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