2010年7月27日 星期二

Barmy days at the AED

In days of yore when I was under training in Internal Medicine , rotation through AED was seen as a necessary evil by most young doctors .
It was the norm to drop inexperienced first/second year medical officers to the battle frontline which was the AED, where they were expected instantly to handle , with minimal supervision, whatever kaleidoscope of trouble humanity can possibly conjure up, some horrendous and some hilarious .
Indeed I've always viewed AED as a microcosm of the wider world outside, filled with blood, sweat , tears , and thank God , occasional laughter . In hindsight the AED was probably the best " swim or sink " training ground for a young doctor and one was forced to grow up very fast .

The 80's were crazy times . Discos were in , there's money to be had, the scents of possibilities were everywhere , emotions ran high and everything's a little larger than life . We were young, unsophisticated and guileless, wide-eyed naiveties , eager as puppies .

Those were the best years .

Economy in HK was beginning to boom and Kwun Tong , where UCH ( United Christian Hospital ) was , was the hub of factories of all description . Safety regulations of the factories were lax and it was almost a monthly event for the ambulance to rush in some unfortunate factory worker, clutching a severed body part in a plastic bag filled with ice - a finger, a hand , a foot or a toe ; mercifully scenes like this are now rare, now that all the factories have moved north into China.

Another peculiarity in Kwun Tong where gang fights abounded were stab wounds. There were so many cases the then SMO of the department made a special study of different types of stab wounds and gathered enough material for a paper in a year. He presented the paper at an AED Conference in England and I was told made quite a big impression . Sometimes the fights continued in the AED, the mob members shouting and gesticulating at each other across the cubicles in a show of bravado , the taste of blood in the air , flashing tattoos and thick gold chains added urgency to the commotion .

Fights were, however, not a prerogative of the patients . We were horribly under-staffed and were constantly under huge pressure to speed through the mountain of cases . The long wait in the stifling heat rendered tempers raw. Kwun Tong was not dubbed the Red Indian District of HK for nothing , and the local residents were forever ready with verbal abuses and complaints which came thick and fast. All of us needed to put on mental and psychological armor just to go to work. It took very little provocation to ignite an argument, and a beefy Taiwanese doctor , football captain in his old school days , snapped under a particularly vehement bout of taunting and launched into a fist fight with an equally beefy man .

This was of course long before the meek cowering HA regime, and while I don't condone fights in general, nevertheless felt this incident did put flesh and blood on the human behind the white coat : push us hard enough and we react like everyone else .

The law of nature dictates that catastrophes always happen when you least expect it .

It was a slow Sunday morning and I was just settling down in a side room to tackle the C.C. cases , all the while trying to pull my scattered wits together after a heavy Saturday night of gallivanting. I heard loud bangs and sounds of locking of doors , and sauntered out to investigate .
"Keep down !" The Sister-in- charge screamed at me . " The man's got a gun !"
It transpired that a middle-aged man with paranoid psychosis was convinced his wife was having an affair and was making such a scene in the waiting area that the rookie police officer assigned to guard our AED was called to intervene . Somehow in the scuffles the man managed to seize the policeman's gun, and was now brandishing it about menacingly .
There were maybe 30 odd people in the waiting room and everybody hit the floor as if on cue . Confusion reigned supreme : men were shouting and old ladies were weeping , it was chaos ran amok !

The set-up of the AED at UCH at that time was such that the waiting area was separated from the AED proper and there were only 2 doors that connected the two areas . The Sister on duty took charge , decided to put staff safety first and promptly locked us all in , meanwhile radioed the Kwun Tong Police Head Quarters for assistance .
The minutes weighted like years while we waited for the police back-up, and we all felt it was unsafe for everybody to wait any longer . Just then an ambulance pulled up at the gate.
The ambulance men quickly devised a plan : one of them would distract the man , the others would jump on him from behind, and the charge nurse would ram a syringe- full of sedatives into the man's thigh .
Fool-hardy though the plan was, it worked !

I'd a lot of respect and fondness for the ambulance men, the last of the gallant chivaric knights in this day and age where kindness and courtesy dwindled in the wake of gender equality . These guys took particular good care of the female doctors .
It was the practice then that all dead bodies, however decomposed and mangled , had to be brought to a doctor to be certified before they could be transferred to the mortuary , and it was the duty of the AED medical officers to perform this grisly task .
The ambulance men would brief us in advance ," This one's real nasty, doc !" They'd say sympathetically , " Hand me your steth. and I'd place it over the heart for you " as we gingerly advanced in our flimsy gloves , eyes screwed narrow against the stench .

The changes in AED clientele and usage profile reflected the social changes in HK . As part of the population became wealthier and could afford private medical care the disadvantaged and under-privileged grew in proportion in the patients we saw .

In the 80's HK was hit by a sharp influx of new immigrants from China and staggered under the weight of the Vietnamese refugees .
One of the first cases I saw while working in the AED was a young Vietnamese woman from the Refugee Camp . She was 5 months pregnant , brought in after being stabbed in the abdomen by a deranged fellow inmate with a knife 2 feet long . She was lucky to have survived as the knife narrowly missed the aorta, and miraculously the baby was also unharmed ; only a couple of sections of her intestine needed patching up .
I later learnt assaults were common occurrences and people frequently go berserk in the Camp .

We were the nearest hospital to the Kai Tak Airport , that's why we were the main receiving hospital when a plane ran off the air-strip into the sea in one of the worst air disasters in HK , and why when a Japanese tourist exhibited strange behavior at the Air Terminal she was sent to us .
She was a well dressed and well groomed young woman , obviously agitated and talked non-stop in Japanese .It was difficult getting close to her for any proper examination and the only 2 words I could make out from her torrents of speech were : "Jackie Chan " .
She appeared to be either manic or was on drugs .
" We've got to call the Japanese Embassy " I told the nurse " I'm getting nowhere. “
After a string of phone calls an official from the Embassy arrived , and finally her story unfolded ,
The young Japanese was obsessed with Jackie Chan, and had flown specially from Japan to meet him . She was also seriously disturbed as she was under the delusion that though they've never met , Jackie had promised to marry her, so she was livid when he was not at the Airport to claim her . By a stroke of luck the Embassy managed to contact her mother and she did have a history of mental illness. The Japanese official agreed to arrange for her to go on the next flight back to Japan , apologizing profusely the whole time for all the trouble his countrywoman had caused .

Love must have been in the air .

A good looking young doctor rotated from the Psychiatric Unit to AED and brought an admirer with him.
A female psychiatric patient he treated couldn't stay away, fortunately her ambitions were small . Everyday for weeks she'd find out his schedule, and would wait patiently at the entrance to the AED for him, a single red rose in her hands. She'd hand him the rose when he appeared , then leave quietly.
One could only wish all cases of transference were so sweet ! Needless to say this doctor was the butt of all our jokes for a long time .

On the other hand love gone sour could be mean and vengeful.
I was startled by a young woman who committed suicide by hanging, dressed from head to toe in red – red pyjamas, red shoes, even red socks and underwear . I was told the fiery red shroud would enable her to haunt her lover forever from beyond the grave.
As young doctors trying to cram a 30 hour work- and- study day into a 24 hour day, we all suffered from severe chronic lack of sleep. Many days I could have fallen asleep standing up, so for the life of me I couldn't figure out why anyone would create so much work for herself even after death !

When I was a kid unless I was running a fever of 104 and convulsing, my parents would never dream of taking me to the hospital and use the hospital service . The spate of new immigrants from China altered the concept and usage of medical welfare for ever.
It was 2 AM during one night shift that I saw the beginning of the “ambulance as taxi “ culture - an able-bodied man called an ambulance to the AED for sore throat , then had the gore to demand an ambulance ride home after he's collected his medicine !
HK has got to be the only place on earth where sniffles are considered legitimate medical emergencies !

From time to time we'd have gentlemen turning up with problems pertaining to their genitals, for which one humorous medical officer conned the phrase “ Male Gynae cases “.
I was set ready to leave one night when I was waylaid by this particular MO. "You've got to see this !” he said mysteriously , and led me to a diminutive middle-aged man huddled in a bed , trembling in grey sweaty panic.
" Show the doctor !” he commanded , and the man unveiled his genitals , tied with a bit of red string which he was desperately tugging at .
“ This is Koro “ the MO announced triumphantly .
“ Oh, yeah !” I said, trying to downplay my ignorance .
I later found out Koro's a very old superstition peculiar to the males of South Eastern coasts of China and Malaysia , characterized by the belief the penis is being pulled into the abdomen by a spirit of evil intent, at the moment of its disappearance they die .
This just shows the diversity of knowledge required to work in the AED .

A day in the AED is tedious, is exciting ; is mundane, is exhilarating; is boring, is fun; is exasperating, is gratifying .
The whole of life's drama could be played out in the AED. Day in and day out.

In the one and a half years I worked in the AED I'd uncovered incest, comforted the raped, resuscitated the drowned, handled electrocution victims , saw an 8 year old being handcuffed for allegedly killing his 9 year old brother , politely declined offers from psychotic Jesus Savior to purge my soul , restrained young girls high on Mandrax , patched up shattered bones in all kinds of accidents ........... and the list goes on . Of course it was not all slaying dragons, I also saw a million coughs and sneezes , diarrheas and ingrown toe-nails .

Although it's been a long time since I worked in the AED, what I remember and miss most is the camaraderie between all the AED staff - we'd built bonds that can only exist between people who've fought battles side-by-side on a daily basis . We the staff as well as the patients are all teachers of one another in this crash course where we learn to expect the unexpected , believe in even the absurd , question even the ordinary , humbled by the resilience of the human spirit , and despair over the incredulous follies of feeble judgement .

Although Emergency Medicine is now a Specialty in its own right and AED is no longer a stop-over for young doctors , I expect the work is still intense and there're always new challenges on the horizon . I can only imagine the anxiety that gripped the AED during the period of SARS , and I salute all the AED staff in their valiant effort to overcome the odds and to create their very own new page of history.

These could be the best years .

This article was published in the " From Casulty to Emergency Medicine - Half a century of transformation " , by the Hong Kong Academy of Medicine Press in 2004