29 April 2008

Malaysian Hospital Series 0001

Malaysian hospital series 1 - the IM injection

When I've been sent to the A&E (Accident & Emergency) department, again that morning, this early April, as usual they transport me to the critical/less critical observation room using the stretcher. Even though I am about in an unconscious condition, but I try to focus on their conversation in order to get the updates. The doctor asked me few questions and I hardly answered them, having to repeat my words few times, and end up with misunderstanding. I do think they could easily dig up everything from those who accompany me (Najwa & Bro Halim) to the A&E rather than asking me on my condition.

I was at that time vomiting non-stop and having terrible pain in the brain. I cannot lift my head even a bit and need to be in recumbent supine position (baring kepala mengadap atas) in order not to cause greater pain in the brain. Mengiring pun tak boleh, duduk pun tak boleh, ape pun tak boleh. Hanya baring sahaja dibenarkan oleh kepala selama hampir 3 hari. That was actually due to a procedure i received few days before in the ward.

Then, I heard they wanted to do the IM (intramuscular: which means within the muscle) injection as the first procedure to reduce the pain I suffered of.

“Please, no...” I refused slowly right before they take out the drug (sambil geleng-geleng kepala kot). Few times I refused as they kept arguing with me.

Firstly because it will lead me to vomit, this is the effect of some drugs to the body. At that particular time, I already vomited non-stop every minute. Hence, considering my own QOL (Quality Of Life) for not giving extra harm, so I refused to. Even I did not know what type of drug they wanted to give, but I don’t care. I am afraid it will become worst, I will vomit more. I prefer to bear with the pain rather than having some more drug and keep vomiting.

Secondly, as you know, IM injection is very much painful, during and after, even this is not realy the reason why as Im used to the injections. IM is not like the pain with IV (intravenous: within a vein), it is very much different. Instead, IV is actually not painful at all. I am not really sure why IM is much more painful as I’ve seen many people end up with tears after IM injection. And I myself have experienced of IM many times, previously it was given to me at least every month.

In addition of that, the night before, the doctor on duty already did the injection for me through IM at the A&E. After that she let me go back to UIA and requested me to come back tomorrow morning if it’s becoming worst. It did. Thus, there I am the next day with the half conscious condition. I went only after a very bad condition. The bloody-minded me (read: degil).

So, that was the third reason. Even though, the doctor still argued with me. For sure I did not give any reasons, just refusing (read: geleng kepala). I do think the doctor should understand why, just by looking at my condition and applying the patient’s QOL without having to ask to. If not, after the injection of the drug through IM, they need to give me another injection to reduce the vomiting (fast action rather than orally) [please correct me if I am wrong].

I wonder why IM injection is painful. For some people, the pain is still there for two to three days later. From logical assumption with some friends, it might be due to the reaction of the drug as IM would not caused pain if it is done properly (read: ye eh..? What does it mean with proper technique?). For IV, logically it would not cause any pain as it goes through the blood vessel. Aite?

Just logical assumption, I tried to search, but did not found any information. So, this is only one part of it which I wanted to share. I guess I’ve talked a lot about needle, syringe and so on in my previous post. Yet, this is not the last, there will some more soon, Insha’Allah, in another sharing corner, because sharing is caring.

The moral value? Maybe before taking any further actions, we have to consider patient’s condition. Something which is looks necessary is not always right. This could be applied not only in the healthcare field, but also in our daily life. Again, patient is a living entity. Thus, please beware!

Wallahu’alam, a reminder for me and for you. Till then, wassalam.

P/s: to be continued on the next series, inshaAllah


nurul 'izzati abdullah zayawi said...

i my opinion..

IM tu sakit sbb kite inject kat muscle..dia sakit la..sbb muscle tu akan buat kerja..kalau cam IV tu dia terus masuk blood..blood kan dia akn circulate je..so kite xterasa sgt..ni bg la general view je la..msh bljr..huhu..bak kate as juge..cam kite inject bcg..

ok take care dear..
continue ur story..xsabo nk bace..

Anonymous said...

depends on the location of the IM la. as kene im kat mane? area gluteal ke deltoid?

kalau cam kat area gluteal (punggung) tu pun, depends on gak. patut IM buat kat upper-lateral side, so that jauh dari divergence of sciatic nerve. camtu tak rasa sakit sangat.

byk lagi faktornya.. maybe diorg cucuk kena kat artery.. or maybe projectory angle jarum tu tak tepat. and also maybe sbb ubat yg diinject tu sendiri.. hatta saiz badan pesakit pun jadi faktor..

tabah! be tough! =)

NMZ said...

to Zaty:
na'am, benar2.. :) might be muscle trigger pain receptor, but as we all know, vein tak.
Heh, bile rajen nanti patik menulis la next series ye zaty, bukan senang nak bukak cite sendiri. He..

to Kid:
As biasa kat deltoid. SCiatic nerve memang, kalo masalah kat spine pun symptoms ade shown kat sciatic nerve jugak, kan? Ke tak?
Biasa yang as tengok inject kat deltoid angulaton die 90 degrees, perpendicular dengan bahu, memang camtu eh? Maaf, memang rabun sket bab ni.
Thanks for the advice, all the injections, alhamdulillah, being a normal things to me, we'll talk about this on the next series soon, inshaAllah.

Anonymous said...

ye kot. hehe. x blaja lg bab2 pathologic nih. =p

ha'ah 90 degrees perpendicular jugak rasanya. tapi movement of needle tu pun penting gak. exit angle kene parallel dengan entry angle. kalau senget jadi boleh damage la kat muscle. huhu.

Dr-2-B-Zul said...

salamullahi 'alaikum..uish hebat2 smuanya..xkesahla yg dr cbg medic ke x..tp raseny mcm bdk2 medic je..ayat yg dicicah ilmu medic pun sedap2..just nk kgc sket,pndpt yg x seberapa ni..xkesahla..IV ke IM ke..sublingual ke..bg sorg patient mayb yg ada dlm benak dia,2 benda je..nk cepat sembuh,n xnk sakit sgt..tp bg kondisi as,mayb lain sbb dia byk gak tau psl medic ni..so bg ana la,ana cuba nk backup doc tu..bg certain case,mgkn kita rasa kita tau..tp memndgkn ilmu Allah ni luas sgt n ilmu kita ni klau nk cmpare dgn ilmu Allah tu hanya setitis air di lautan,kita kena consider la yg doc tu lebih tau dr kita..IM injection mayb painful..tp lebih baik kita rasa pain tu dr condition kita worsened..dr aspek perasaan plak,memg doc tu kena jaga hati dan perasaan patient,tp ada ketikanya doc trpaksa mematuhi fiqh aulawiyat(utamakan yg lebih utama)..mayb x sama dgn skop kisah ni,tp mgkn bleh diteliti dan difahami..maaf klau terlebih berceloteh..k..salam..

HafizAdam said...

She wrote based on patient's point of view. sape taknak sembuh kan? so kalau doc da tau side effect, ape yg perlu dye buat? that's the main point utk difikirkan.

p/s: sbnrnye payah gak. org kate, kdg2 kekejaman tuh sbnrnye perkara yg baik.

djambu puadovich said...

rasanya sakit tu sbb otot tu yg terjejas sbb kene cucuk...
mungkin jugak sbb ubat tu nak amik masa nk meresap ke seluruh badan. kalo IV, dia terus je ikut aliran darah

NMZ said...

to Dr-2-be-zul:
Yup, benar ape yang zul kata. Memang itu yang patut Dr buat. Sebab itu prosedur yang dia rase baik. Tapi ape yang perlu tak semestinya sentiasa betul. But rather it is applicable on other situations of coz.
Cuma in my situation, by taking the drug my condition will be worsen, as akan vomit lagi teruk. Itu kan menambah sakit jadinya. As tak kesah rase sakit injection, sebab alhamdulillah dah lali dengan sume tuh. Badan ni pun dah mcm fragile asyik kena tembus jarum, hehe.
In my condition that time, doktor taknak jaga hati dan perasaan pun takpe, but please dont give extra harm to me. Itu yang asyik terfikir masa tuh.
Tapi trimas untuk pandangan tuh, banyak lagi benda yang kita perlu consider dan teliti. Syukron lak.

to Apiss..:
Sebenarnya masa tuh doctor tatau dah nak wat pe sebab die salah faham pe as cakap. Yelah duk tanya kita yang tengah sakit and muntah-muntah. Nak cakap pun tak daya dah. Heh. That's why die eager nak bg drug to release pain. As terfikir gak nanti da dapat drug then mamai, padahal duk tengah vomit lagi. I have to take care of my ownself, dats why I have to think further.
Kalau die tanya condition as kat those yang accompany as pun senang sket die nak proceed. Tulah comunication sebenarnye. Sebab time tuh tak ramai patient dalam bilik tu.
Kekejaman tu perlu, but when it is applicable. Sebab tu as cakap, jangan bg extra harm to patient, harm takpe bile perlu, tapi jangan tambah lagi ape yang tak perlu. Begitulah...

to djambu puadovich:
wah bangga dapat eja betul nama nih. Hehe. Benar2, mungkin reaction during and after injection tru muscle.
And most probably because of drug react dengan tissue during, and spread around after injection. Mungkin...as pun tak sure, jas logical assumption..

HafizAdam said...

len kali suh doc bg general anaesthesia sblm inject..haha

NMZ said...

nak buat ape inject general anaest, manja namanye tuh..huhuhuhuhu...
dun look down on me, I've experienced LP (lumbar puncture), you know how great the pain aite? =P