Sunday Mar 7, 2010. Without the intense pain and hunching over as 2 days ago, his voice sounded normal and strong. One of the lucky few to be alive.

Flash back to Friday. Mar 5, 2010.
At 9am, I got him to Tan Tock Seng Hospital (TTSH) Emergency Department as he could barely speak and suffered a pain so intense that he hunched himself inside my car. He was the stoic type and wanted to wait for his wife to come home from Malaysia. He diagnosed he was suffering from appendicitis, the intense pain being in his right upper abdomen.

My assistant Mr Saw phoned me at 8.30 am to ask whether he could take leave to accompany Mr Ang. "The best thing is to get Mr Ang an ambulance," I said. I decided to get Mr Ang to the hospital as he was in great pain. Yesterday, he had eaten nasi- lemak and thought the gastric pain was due to that.  At 4 am, he had an injection from a GP at a clinic nearby but the pain never subsided.

Mar 5, 2010. 9.30 am. Warded.
5 pm. He was in great pain. There was a long waiting list for the CT scan or the specialist was not available. His wife was worried when I phoned. However, the junior doctor did not wish to speak to me. The nurse did. There was a queue for the CT scan. But this patient was in intense pain. "The wife has agreed and will sign the surgery consent form for the exploratory laparotomy," I asked the nurse whether the surgery could be performed. The nurse was kind enough to say she would talk to the doctor but would give the stoic man a painkiller. "Is pethidine injection OK for my husband?" the wife asked me over the phone. "Yes," I said. The stoic man fell asleep.
8pm. Still waiting for the CT scan. So the stoic man had to tolerate the intense pain.
10pm. My associate visited the stoic man and talked to the doctor who seemed to be too busy to talk to him. "The corridors were full of beds with patients," Dr Jason Teo  told me today. "The nurses seemed over-worked and the doctors do not have time to talk."

At 12 midnight, Mr Ang was operated and his appendix was removed. He recovered well and was discharged on Sunday, March 7, 2010 at noon. I phoned his wife at 11 am offering to pick him up. His wife said, "Thank you, Dr Sing. It is OK. We can get a taxi". When I persisted, she said, "Dr Jessie is coming to pick him up." Why didn't she say that in the first place, I don't know. Beating around the bush. This is part of her personality.

Mr Ang was a fortunate man. A man who talks straight. No beating around the bush. This is why I respect and like him.

In his case, any further delay in his surgery would mean a ruptured appendix leading to peritonitis and septic shock. He would be dead as it is hard to treat peritonitis from a ruptured appendix, with all the gut contents spilled into his abdomen.

This was a stoic man. I knew because he had suffered similar abdominal pains and had bought medicine for himself in Myanmar when I was touring with him. I remember one evening in a town in north Myanmar in December 2008. We went to a drug store to buy medicine for his stomach upset. Now in March 2010, he diagnosed himself as having appendicitis. I suspected that his appendix would be about to rupture as he just curled himself in the backseat of the car, not complaining.

P.S. The Sunday Times, March 7, 2010. HOSPITAL BED CRUNCH.
There is a hospital bed crunch in Singapore's public hospital. TTSH, one of the 6 public hospitals has the most number of Accident and Emergency (A&E) patients, numbering over 500 a day. It has an average occupancy rate at midnight of 89%. This would be good if it was a hotel. Non-emergency operations had to be postponed and patients have to be warded on beds at corridors! 5% of the A&# patients waited more than 8 hours for a bed in January 2010. What Dr Jason Teo saw at 11 pm would be an over-booked TTSH. So, he saw some patients on beds in the corridor on March 5, 2010 and was shocked. I asked him to read the Sunday Times.  

It is likely that Mr Ang was one of the 5% in March 2010. The hospital needed a bed for the patient after surgery. At 89% occupancy rate, there will be days when there are practically no hospital beds available. Patients will be bedded along corridors.

So, it was fortunate that the stoic man could get a bed after operation and be alive today, Sunday. His voice was full of bounce and energy and it was great to know he was alive. One cannot take for granted that one will live during a medical emergency.

I remembered very well this young man who consulted me about his old Rottweiler with cancer of the abdominal testicle as shown in an X-ray taken by another practice. I knew his aunty well and she had referred him to me for a second opinion.

Some months later I enquired about him as he was a personable outdoor young man who came back from the USA and had opened an adventure tourism business. "He died due to low platelet count," the aunty said the nephew had contacted dengue fever. He had been admitted to the public hospital. He did not get a blood transfusion which would have saved his life. When confronted, the doctor told the aunty bluntly, "You should have had admitted him to a private hospital in the first place."

Arising from this episode as I feared for the worst for Mr Ang, I cancelled my Friday morning appointment, drove to his place and got this old friend, to TTSH immediately. He wanted to wait for his wife, not wanting to trouble me and knowing I had to consult. His wife was somewhere in Johor overnight. Any waiting for a medical emergency would not be good for him. 

In conclusion, be proactive to help your loved ones. A patient in a public hospital is just one of the countless digits for the doctor. Everyone claimed to be an emergency in the A&E Department and therefore, the doctor is over-burdened and overworked. I didn't know that TTSH was the most popular A&E hospitals out of the 6 public hospitals at that time when I drove Mr Ang there. 

If the family members and friends don't take an interest in the patient or don't know how to do it, the patient may just die in a public hospital. Seeking treatment in a private hospital may be too costly and therefore the public hospitals are over-loaded recently.   

Decisions and permission regarding emergency surgery must be made promptly. The same applies to pet owners. Recently I heard of a case which all vets would not want. A dog was diagnosed with pyometra. The owners could not decide whether to get it operated on, knowing that it dog might die on the operating table.

Many family owners were consulted but no decision could be made. This delay permitted the disease to progress. By the time a second opinion was sought, the dog was still alive. It died at the second vet's practice. The first vet was harassed by phone calls and text messages and blamed for the dog's death.  In the first instance, the first vet's advice to operate was ignored and the dog was brought home. A second vet was consulted. Emergencies can't wait and that was why I advised Mr Ang's wife to permit an exploratory laparotomy (open the abdomen to find out if the appendix was inflamed). She agreed, with lots of worries.

However the doctors want a CT scan and there was a queue. I presumed that TTSH has only one scan. The specialist was not available immediately to read it, according to some nurses. There were delays. After the CT scan was done, Mr  Ang was operated. This was the impression I got. In the final analysis, results count. A live Mr Ang at the end of the day is what matters.  Maybe, Mr Ang should not be eating nasi-lemak anymore this dish caused him gastric pain too and might have masked the diagnosis of appendicitis and delayed surgery.