11:06 PM

Action speaks louder than words

Bismillah

ONG- Rotation week
ONG Outpatient Clinic, King Abdullah University Hospital
Ultrasound Room

A mid- or late-thirties housewife, G4 P3 (read: this is her 4th pregnancy, with 3 children) , on her 18-19 weeks of gestational age (more or less, couldn't remember), attending her regular monthly antenatal care. She complained of decrease fetal movement 2-3 weeks prior, but few days ago (or 1 week ago), she couldn't feel any of the fetal movement.


Doktor pakar memulakan pemeriksaan ultrasound. Sudah dapat dilihat pada skrin bentuk tubuh janin yang diperiksa. Doktor mengambil ukuran-ukuran yang sepatutnya (biparietal diameter, femur length, abdominal circumference). Ada tanda tidak menyedapkan hati.


Gambar hiasan


Ukuran yang sepatutnya menunjukkan umur kandungan dalam jangkaan 19 minggu ke 20 minggu, menunjukkan angka 17 minggu dengan ralat 'plus minus' beberapa hari. Eh, janin tidak membesar berbanding scan yang dibuat pada appointment antenatal care sebelum ini. Sepatutnya janin membesar berkadar terus dengan umur kandungan.

Doktor memeriksa lagi, kali ini mahu mencari denyutan jantungnya. Hmm.. betulkah ini? Cari lagi... hmm.. teliti lagi scan tu...

Lama juga ketika itu, saya tahu bukan doktor tidak terjumpa di mana jantung bayi, tapi ada perkara yang lebih besar yang doktor lihat- tiada denyutan jantung pada janin. Ketiga-tiga kami (the specialist, the resident, and the student) senyap. Dengan tiba-tiba doktor bersuara,

"We need someone to lie...."

Saya terkesima.. Adakah beliau tujukan ayat itu kepada saya..?

"Regarding the absence of fetal heart beat?"

"Definitely, that is our matter right now"

Saya tahu dia sedang bergurau ketika dia nyatakan yang kami harus menipu.

Selepas dialog itu, suasana kembali bisu. Kami bertiga memandang skrin ultrasound macam nak masuk ke dalam skrin (kami bertiga..? mungkin hanya saya yang kelihatan seperti mahu masuk ke dalam skrin, excited dan curious sangat). Senyap lagi beberapa ketika, mungkin masing-masing sedang merangka ayat untuk diberitahu pada si ibu.




Namun tiba-tiba si ibu bersuara....

"Anything wrong, doctor?"

Pertanyaan dalam wajah yang tidak tahu untuk saya gambarkan. Risau, dan ingin tahu bercampur dalam riak tenang wajah seorang ibu. Akhirnya, itu memudahkan kerja kami apabila si ibu sendiri yang dapat menghidu suatu yang tidak diingini. Kami hanya perlu menjelaskann sepenuhnya keadaan sebenar selepas ibu bertanya. Dia mungkin sudah bersedia mendengarnya.


ACTION SPEAKS LOUDER THAN WORDS

Kami tidak perlu memulakan bicara pada awalnya. Sikap kami yang menimbulkan tanda tanya
merupakan satu petanda. Doktor pakar yang selalunya tidak sampai 5 minit memeriksa perkembangan janin yang membesar dengan baik, mengapa kali ini mengambil masa labih lama? Mengapa pula si pelajar perubatan ini berkerut dahinya serta wajah doktor MO yang seolah sedang fokus melihat dan mancari sesuatu dalal skrin ultrasound itu.

Perbuatan kami seolah-olah satu pemberitahuan tanpa suara untuk si ibu cuba faham ada sesuatu yang tidak kena, dan cuba untuk bersedia.

Dia redha....


BREAKING BAD NEWS AND A WARNING SHOT


Seorang pakar Family Medicine, pernah sekali menerangkan kepada kumpulan kecil kami apabila ditanya oleh rakan sekumpulan tentang kaunseling dan "breaking bad news".

Give a warning shot....




Apa itu?

Tembakan amaran?

Tembakan amaran tanpa bunyi tanpa suara....


Dalam sesi kaunseling doktor dan pesakit yang diatur, satu cara memberi petanda kepada pesakit tentang berita buruk yang akan diterima tentang masalah kesihatannya dengan REMAIN SILENT....





Wujudkan satu suasana hening dan sunyi dalam bilik itu, duduk di atas kerusi anda dan pandang dengan penuh empati (bukan dengan muka melepek nak nangis, ye) sehingga pesakit sendiri dapat menghidu sendiri ada sesuatu yang tidak kena, dan dia harus bersedia. Kalu boleh tunggu sehingga pesakit yang memulakan bicara... tapi kalau dah lama sangat senyapnya, pandai-pandailah anda sebagai doktor yang bersuara...
Jika pesakit menangis, biarkan, biarkan selama mana dia mahu menenangkan diri. Anda perlu menjadi doktor yang penuh dengan empati...


Saya tidak pernah menghadapi situasi "breaking bad news" ini. Tapi cara doktor menjelaskan, membuatkan saya rasa, ia satu perkara yang berat untuk setiap doktor (dan pesakit sudah tentu) untuk menghadapinya. Susah juga....
Cara kita menjelaskan, cuba memahami perasaan pesakit, sedikit sebanyak membantu pesakit membina emosi yang positif dan bertindak dengan rasional serta tidak melulu (seperti bunuh diri atau sebagainya- memang ada kes macam ni...)

Saya mahu menjadi doktor yang penuh dengan empati (empati tidak bermaksud saya akan turut sama mengangis di hadapan pesakit).


BUKAN BIDANG PERUBATAN SAHAJA

Action speaks louder than words. Paling penting dalam hidup seharian, anda diperhatikan. Sama ada anda menjadi da'ie yang mengajak kepada kebaikan, atau menjadi contoh kepada keburukan. You choose....

Wallahua'lam

80 silent voices:

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