What do you tell someone who’s about to die?

(Disclaimer: I received verbal consent from my patient to share about my experience with him.)

This week I’ve been at the Cardiac Intensive Care Unit, and nothing has challenged me more physically, mentally and emotionally during a placement.

At the Cardiac Intensive Care Unit, many patients come in after suffering heart attacks. They are in critical need of care, where many patients are vulnerable and are fighting to stay alive… and the healthcare team fighting to keep them alive.

The week began quite calmly, which gave me lots of reading time, but since yesterday and especially today, I’ve been running.

Running. Trying to learn and help out during critical situations, but mainly trying to keep out of the way. Running to wherever the alarm rings. Another patient is dying. Every second counts.

Yesterday, in the midst of a flurry of doctors and nurses trying to save another patient from a cardiac arrest, everyone leaves the room to discuss. At this point, several life-saving electric shocks had been given, and I was there to witness them all. Even seeing the patient in pain.

I tried fighting my tears as I realise, I don’t like seeing patients in pain. And I really wish I don’t ever have to. But there I was.

I was left alone in the room with the patient and I take their hand to comfort them. The patient then looks at me straight in the eyes and tells me:

Jag kommer nu.” – “I’m coming now.”

Coming. Coming to a place beyond us. Coming to death. Coming to what I like to believe, life after death. Coming to Heaven.

I was silent, again fighting my tears. I look straight back not knowing what to say. What do you tell someone who knows they’re about to die, and you know it too? What do you tell someone who’s about to die?

*

This question wracked my brain until the next day. Could I have said anything to improve the situation? What if that really was the last chance I got to talk to them? What if I was the last person they spoke to, and I couldn’t even say a word?

Fortunately, this story has a happy ending. After a rough night and morning of more emergency interventions, the patient is alive and recovering. I finished my day early and decided to pass by the patient’s room to talk to them. It didn’t really feel right for me to leave for the weekend, not knowing whether they will be okay or not when I return. I waited for their room to be free, came in, and in the end I stayed for over an hour chatting. At the end of it they took my hand and told me:

“You have an important duty to pass on your genes to the next generation and I hope you have many children… but be careful with your choice!”

I promised I will, and in return I made them promise they will be around when I come back after the weekend.

As a medical student, I usually joke that another day at the hospital is another life saved, but now I realised this is not a joke at all. As healthcare workers, we are given the unique opportunity to make great changes in people’s lives, and sometimes even save a life. However at times, we are also there as they take their last breath. Being prepared for both scenarios would make the best impact on people’s lives and today, I realised I still have a lot left to learn.

heart ECG tracing recording

 

How I developed radial tunnel and lost the ability to play the violin

Five years ago, possibly owing to my Type A personality and absurdly high expectations on myself, I lost one of my biggest passions at the time, which was the violin.

Starting at the age of 16, I decided to pick up the violin again after a hiatus of three years. I auditioned and started taking lessons and playing in an orchestra at the Royal College of Music in Stockholm. I quickly picked it up again, and starting from playing in the furthermost row in Violin 2 in my orchestra, the following year I was playing in the front row beside the Concerto Maestro in Violin 1. The College also allowed me into their violin vault filled with priceless violins to pick one for myself. After going through several priceless violins, I picked a Danish violin from the beginning of the 1800s. That moment I chose my violin is a very special memory for me, which I can most closely describe as like when Harry Potter chose his wand from Ollivander’s Wand Shop.

Harry Potter chose his wand at the Ollivander wand shop

My teachers at school found out I play the violin, and so apart from the pieces I played at the College, one could see me with my violin at assemblies as well. For all these pieces I was expected to play, I practiced at least 4h a day, especially during concert season nearing the summer. People had very high expectations on me, and my expectations on myself even higher. I had my violin with me everywhere, we were inseparable.

Nearing the end of concert season right before the summer of 2011, I suddenly would start getting severe shooting pain and numbness/tingly feelings in my fingers in my right hand/arm. My doctor told me I needed to rest and was referred to a physiotherapist. But no. I was going to finish concert season.

I would hide my wrist splint prescribed to me by the physiotherapists every time I came to the College, so my teachers won’t know I’m actually not allowed to play. Eventually my arm got the best to me near the end of concert season, to the point I couldn’t move it for an entire month. I skipped exams as I couldn’t write anymore (I’m right handed and that was where I got injured), attended my medical school interviews wearing a wrist splint etc. It was very hard on me physically, but even harder on me emotionally. But somehow through it all, I managed all my concerts.

At the end of concert season, I told myself I need to rest my arm. I rested it until I moved to university in St Andrews. I started playing a little for myself there, but I still kept getting pain. Now the pain was persistent every time I used my arm. I lost the ability to play the violin.

https://www.instagram.com/p/JDtd-roN9x/?taken-by=fileea

The following years, I sought healthcare back and forth in the UK with no result. I started getting physiotherapy including ultrasound (or what my teacher calls whale song therapy) and was prescribed NSAID anti-inflammatories. I started getting tested in various ways such as X-ray, MRI, electrophysiological tests you name it. I was given different diagnoses all the time and met various doctors constantly. Carpal tunnel, tennis elbow, repetitive strain injury, tendonitis… but none of them were correct until I came back to Sweden after four years in the UK.

I was referred to see a hand surgeon who happens to be a lecturer at Karolinska (my friends remember him and said that when they came out of his lecture everyone wanted to be hand surgeons!) and within 30min of hearing my story and examining me, he decided that I was to be operated. I was finally diagnosed with the correct diagnosis – radial tunnel.

It has gone three weeks since my operation and right now I’m on my way to Stockholm to see my hand surgeon for the first time since. We’re finally removing the steri-strips (the protective layer applied on the surgical site during the operation) and I’ll be seeing my surgical scar for the first time. Or my battle wound as I’d like to call it. My violin battle wound.

Soon I can play the violin again. Soon I can return to one of my passions. Soon. ❤

girl with violin from the Royal College of Music in Stockholm

This is a photo of me and my precious violin from the Royal College of Music in Stockholm five years ago when my problems started. This was the last time I could properly play the violin. My violin was repaired in 1862 by a Danish instrument maker named G. Enger in Copenhagen.

Tonsillectomies are not just routine operations anymore

Sorry for the hiatus, but I am finally feeling better now. I have returned to my normal activities-ish. I now only have a plaster over the surgery site and wear a wrist splint every now and then. Thankfully, my recovery was quick! I promise to write about the surgery and put photos ASAP!

*

I am currently on my ENT (Ears, Nose and Throat) placement, now on my final week. Last week due to my newly operated arm I missed more than half the week. But I’m bouncing back now!

Yesterday I attended my first ENT operation (tonsillectomy) ever. This is the first time I’ve attended a surgery for almost a year, and almost two weeks after my own surgery. Suddenly, after being newly operated on myself, my attitude towards operations have changed. It really is different when you’ve been on the other side of healthcare.

Despite tonsillectomies being routine, a range of new thoughts popped up in my head that I’ve never thought about before during operations. Thoughts such as:

  • I wonder what the patient is dreaming about right now. Are they dreaming?
  • Would they remember being woken up and leaving the operation room?
  • How would they react now that their tonsils are gone?
  • How long will their pain last?
  • I wonder if they’d be able to go back to work/school with their throat – sooo painful…

I no longer only think about the long term effects of the surgery, but how the patient will feel right after the operation. I was there too. You enter the hospital with full control of your body and feeling okay. Then you go to sleep, and all of a sudden, you wake up and everything has changed.  

After my operation, I was in pain. I was in such excruciating pain in my arm, that I was dependent on strong opioids such as oxycodone and morphine. I remember how debilitating it was, and how one was so helpless and dependent on others. The pain took over one, and all one can do is wait until it passes – or until the opioids knock you out. But then you wake up several times in the night with the pain needing more. Then you take more painkillers and can finally fall asleep again…

When I see a patient get operated now, I can relate. I can relate to their fear, anxiety, and sympathise for the pain they will undergo post-op. I recall how it was for me and realise, even though this is one of the hundreds of routine tonsillectomies done, the bi-product of the operation itself is the same. All patients will experience a change in their daily lives, with its impact highly underestimated in the beginning. That was definitely the case for me anyway. Of course I think like myself too, all patients are willing to undergo it. Patients have so much hope and trust in the treatment, that its bi-products is long overweighed by its benefits.

After being a patient myself, I understand now why patients feel the way that they do before an operation – even one as common as a tonsillectomy. One is scared for the drastic change that is about to happen – both the good and the bad. One is scared because there is nothing one can do but accept the change, and be patient.

https://www.instagram.com/p/BFEPgcpoN6s/?taken-by=fileea

I’m about to get operated.

I know I’m in my fifth year of medical school, I know I’ve grown up hearing about operations, I know I’ve seen countless surgeries… But somehow I’m still somewhat scared. Even though this is a quick and non-invasive surgery. 

It’s definitely a completely different experience being the person on the other side of the bed now. Now I understand what patients feel when they come to the hospital. Now I’m one of them lying here waiting for my turn to get operated on.

In a few hours my five years of pain in my right arm will be over. Soon, I can play the violin again! 

Wish me luck and prayers are warmly appreciated! Time for me to become the patient! 😊

https://www.instagram.com/p/BEvA76lIN3l/

I JUST OPERATED MY FIRST PATIENT EVER

Not gonna lie, who knew that Primary Care/GP/primärvård in Värnamo could be this fun?!

My surgical skills diploma from Manchester isn’t just a paper hanging on the wall anymore! Those general surgery days with McCloy paid off – the best teacher I had in Manchester for sure.

*

Earlier that day, the doctor I was shadowing excised a lipoma, and told me that should another patient come in wanting something removed, I would be allowed to do it under his supervision. Yes I know, he is pretty awesome like that, wanting me to have as much hands-on experience as possible.

Our last patient came in who was a young patient with a congenital nevus (mole), about 3x3cm. Yay I thought, another skin patient and a possible surgery candidate! We examined it and decided that it was benign, but asked whether he wanted it removed anyway – me secretly hoping that he did. He said he wanted it removed. The doctor and I looked at each other and smiled. I GET TO CONDUCT MY FIRST SURGERY EVER!!! 😀

As per my doctor supervisor’s instructions, I injected the anaesthesia, excised the nevus/mole and lastly sutured/sewed it up. All by myself. Except for when the doctor helped me cut the thread after every suture/stitch I put down. In the end it became 6.

After finishing the last suture/stitch, we said goodbye to the patient and left the room. BOOYA. SUCCESS.

It’s gone a few hours now and I still haven’t stopped smiling. I feel so happy and honoured to have been entrusted with such an opportunity which I’m sure I never will forget!

So now baby doctor Sam has performed her first baby operation. I have to start somewhere right? Next time it will be much bigger. Like what my friend said, maybe next time, I will operate on a mole 5x5cm big instead! 😂

https://www.instagram.com/p/BD3S_9TIN9D/?taken-by=fileea

 

Five years later, I’m finally getting operated on

Five years ago I had to give up one of my passions which is playing the violin. It was not only because I was moving to the UK, but also because of a chronic injury on my wrist/arm.

Throughout elementary school and gymnasium, those who knew me always associated me with the violin. I even had the nickname “Violin Sam.” I used to say that the violin was like an extension of my arm. It was a part of me.

I was 17 years old when I got my injury, originally diagnosed as a Repetitive Strain Injury. I couldn’t move my hand/arm for a month and was in so much pain. I was devastated. A part of me was gone all of a sudden. Nevertheless I still kept playing as much as I could, at least to finish the concerts as well as I could. On a positive note I was allowed to skip my Physics final exam because I lost the ability to write – and my grade was pretty much set anyway.

I learnt to live with the pain and occasionally visit doctors and physiotherapists. During my entire time in medical school, I have always used a computer to write my exams. I wanted to be a surgeon back in the day, but quickly ruled that out as I can’t do surgery if I get constant pain every time I use my arm. Goodbye surgeon dream, goodbye violin, goodbye writing and drawing. Oh well.

 

me with my violin from the royal college of music in stockholm

This photo was taken on the day I returned my violin to the Royal College of Music in Stockholm in 2011, a few months after my injury. This was one of the last times I played the violin.

Years passed, and during my first clinical placement at Manchester University, I spoke of my problems with one of the doctors who was my supervisor. Intrigued with my story, he suggested for me to revisit my problem and get examined once again. I followed his advice and went to a doctor.

The constant visits to doctors began. During the entire year I was in Preston, I was examined by various orthopaedic surgeons, underwent MRI, X-Ray, Neurophysiological tests you name it. They didn’t even finish examining me within a year. I was told they couldn’t find anything wrong. When I moved back home, I decided not to give up and continued my examinations here in Stockholm.

I was referred to see a hand surgeon who turned out to be an anatomy lecturer at Karolinska. Within the 30min that he met with me, he diagnosed me with an unusual condition called Radial Tunnel Syndrome. I will have a nerve decompression surgery at the end of April/May.

For an entire year in the UK if not longer, I had to undergo so many tests when the diagnosis could’ve been made within a few minutes.

In other words, I could’ve been okay by now.

NHS, after being both a medical student and a patient in your system, I don’t doubt the abilities of your doctors but rather the system itself. I agree with the headlines – NHS, it’s time for a reform.

I can’t wait to return to playing the violin once again! 🙂