Cardiovert, or not to cardiovert?

My KK life is pretty mundane and monotonous; work starts at 8am, ends at 5pm, and the cases I see are pretty much the same. Uncontrolled diabetes, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hypertension, etc. 

I remember once when I was in Kuala Pilah when I had a unstable SVT in my ward. Thanks to one of my ex-colleague who happened to be in Kuala Pilah A&E then, I have a undiagnosed unstable SVT patient whom was admitted without an ECG being done. And my HO had to inform me about it at 4.30pm, when I was already well-braced to leave the hospital.

It was some 60 yo Malay guy who came in for some funny complaint, was admitted by HKP's great A&E for some funny diagnosis, and was seen by my diligent house officer. So, since his ECG showed AF and his BP was somehow, not that great, my HO informed me and dragged me into the scene.


Well, standard procedures state that any unstable arrhythmias warrant emergency cardioversion, and so I had to counsel this so called pakcik before he drops dead and we end up with even more work to do resuscitating him.


Me: Pakcik. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.
Pakcik: Apa doktor nak buat?
Me: Kita nak kasi current sikit betulkan jantung.
Pakcik: Saya nak bincang dengan isteri saya dulu.


So, I turned my head around and counselled his wife, who was standing beside him.

Me: Makcik. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.

Makcik: Apa doktor nak buat?

Me: Kita nak kasi current sikit betulkan jantung.

Makcik: Saya nak bincang dengan anak saya dulu. Dia nak sampai dah.

Me: Ok...

So, having waited for 5 minutes. I prompted both of them again.

Me: Makcik. Anak belum sampai lagi ke?

Makcik: Dia dah nak sampai. Tempat kerja dia dekat saje.

Me: Dia kerja dekat mana?

Makcik: Dekat Gemas. (On weekdays off-office hours it takes one 1 hour to drive from Gemas to Kuala Pilah)

Me: Jauhlah tu. Nak sampai sini perlu 30 minit, tambahan lagi sekarang masa lepas kerja, mesti sesak jalan. Keadaan pakcik ni tenat, kena buat cepat-cepat.

Makcik: Macam ini doktor talipon anak saya bincang dengan dia-lah.

Me: Ok.

So, after the pakcik and the makcik, it was his son's turn to be counselled.

Me: Encik. Saya doktor yang merawat ayah encik ni. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.

Son: Apa doktor nak buat?

Me: Kita nak kasi current sikit betulkan jantung.

Son: Boleh tunggu sampai saya datang ke.

Me: Ini kecemasan ni. Kalau tak betulkan jantung, pakcik boleh tiba-tiba pengsan dan jadi sangat tenat.

Son: Tak apa, kita boleh tunggu. 

Me: Kalau tiba-tiba pakcik berhenti nafas macam mana?

Son: Itu dugaan Tuhan.

Me: (frustrated) #%$#^&%*#$%$^&^%! Suka hati encik-lah.

As I slammed the phone and started to arrange for this patient's transfer to the CCU ward, this pakcik waved at me.

Me: Kenapa pakcik?

Pakcik: Saya lapar-lah doktor.

Me: Pakcik kena puasa dulu. Nanti kalau anak sudah datang, kita nak buat prosedur bagi current tu.

Pakcik: Saya nak makan juga.

Me: Pakcik kena sabar sikit-lah. Kalau pakcik makan, bila kasi current pakcik mungkin termuntah dan makanan tu masuk paru-paru.

Pakcik: Macam ini matilah saya.

Me: Kenapa pula?

Pakcik: Mati kelaparan. Sekarang pukul 5 lebih dah. Tadi saya tak makan tengah hari lagi.

Me: (spits fire) #%^&*&&^%^%@$@#$! Pakcik kau ni gila ke?Kalau tak kasi current jantung kau akan berhenti dan mati serta-merta. Awak langsung tak bimbang mati sebab jantung berhenti tapi takut pula mati kelaparan. Saya dah malas nak layan kau sekeluarga. Tak faham-faham ke ni keadaan kecemasan.

I stormed out of the ward without turning back. That was just too much to bear. Sometimes, some patients are just not worth your time and patience.