9 May 2008

Malaysian hospital series 0003

Series 0003: The contrast injection and the CT scanning

Below is probably stories to be shared for radiographers to be, nurses to be and radiologists to be. Edited series.

Last few months, I went for CT (computed tomography) scanning for brain once again. Plain and with contrast. Plain means usual examination using high dose radiation while contrast means they use contrast to enhance the region for interest (i.e. brain), with CT as the imaging modality. I won’t mind about the scanning but I am worried if there’s a usage of contrast.

Like what I expected to be, they do extra harm to me (which they could avoid). I was there around 10.30am giving the CT examination form. Then asked to go to the treatment room and I know they will insert in a needle for the contrast and leave the needle there until the procedure was done for about 20 minutes.
“Adik, kat mana senang sikit nak masuk jarum ni?”


The nurse asked me, if I’m a first timer surely I won’t know which one is better. I showed up my left hand. She refused, she wanted the right hand. I showed up my right hand which already been paste with cotton.

“Owh, amik darah ke tadi tangan kanan ni?” The nurse asked again and I just nodded my head. That is why I showed up left hand. Isk3..

“Senang tak tangan kiri ni ye?”

“InshaAllah, biasa senang je tangan ni.” I said.

Then I pointed my finger to the blood vessel, it is obviously seen. When she was about to insert the contrast needle, I reconfirmed with her because she was like teragak-agak.

The needle goes in and I know something wrong, because she pointed at the wrong insertion eventhough the vessel could be seen clearly. It was not going into the blood vessel at all. Oh my, painful. For your information, needle for contrast media is bigger than usual needle which u seen.

“Alamak, silap la dik.” She looked at me, and I just relaxed looking at her. “Sakit tak ni?”

“Tak.”

Yelah, kalau bitau kita sakit lagilah dia cuak buat. The most unaccepted part is when she pointed the needle (which is already in my hand), finding the blood vessel. She moves the needle here and there, to the right and to the left, pointing it deeper and deeper till she reached the vessel. It was very much painful.

“Sakit tak ni?” She asked again. I just keep in silence. No words. Ni belum insert contrast lagi. I said in my heart, because the blood dah membuak-buak keluar. A simple procedure yet so painful, it should be not.


I then waited outside, till they called out my name. With the needle in my hand, maybe area left brachial or left basilic I’m not sure. Painful because of the improper procedure. That was the first part.

Nurse’s view: Macam agak tak confident nak buat
Patient’s view: Kena yakin, patient put the trust on yOu!

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The second part is where they asked me to put off my scarf. I remembered what my lecturer told me, there’s no need to put off your scarf and reveal your hair for this kind of examination. Yes, I know very well, scarf is not a radio opaque material. There shouldn’t be any problems. I fight a bit because I know what I am talking about; I do learn this procedure, but they still sticked with what they said. Thus I just follow their order for not giving any uncomfortable conditions. (Wah, tak puas hati.)

It was always like that in any procedures. It is hard to find health practitioners who really care and concern on patient’s dignity and rights. There was some, as always, but very rare.

Back to the case, they start with the plain scanning, then with contrast, in a large quantity (large to be inserted in the body through venous, I saw the big syringe, very big, never seen before, huhu).

I feel the contrast goes everywhere in the vessel, goes up to the face and the brain. The whole body feel so hot, very hot inside. I feel like to vomit (luckily I’m fasting, no food inside). My eyes become watery, really wanted to vomit. I can smell the contrast, hard odour, even though it was inside the body. It’s end up at 11.30am.

This is what lacking in radiographers and radiologist, they did not know exactly what the patient faced after having the contrast and also what is happening when the machine is functioning, for example the MRI, it produces terrible sound like the machine wanted to burst, this would scared the patients. If they know, they can inform the patient earlier before the scanning. This is important for not giving extra harm to the patients, emotionally or physically.

Radiographer’s view: Kalau buang je tudung and scarf kan senang sket. Lagipun bukan pape.
Patient’s view: It was our dignity which you take as a small matter. Plus, bukan ade radiopaque material.
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To all healthcare practitioners to be, don’t add up what is not necessary and please be concern for what is necessary. Thank you Mr. Zainul for the great advices! InshaAllah IIUM grads from IMC will be much better, amen.
Wallahu’alam.

--Narrated by Anas Bin Malik--

The Prophet said: Facilitate things to people (concerning religious matter), and do not make it hard for them and give them good tidings and do not make them run away (from Islam).

wallahu'alam

14 comments:

dinousar said...

totally agree :) I went for nose scanning-CT Scan. the procedure require patient to swallow 10 tabs corticosteroid, 12hrs b4 and 12 hrs after for patient having history of allergy. prophylaxis of corticosteroids only needed for scanning procedures which need contrast. Based on my experience, I know CT scan for nose didn't need contrast. Having background of pharmacy, I don’t want to experience unnecessary adverse effect of corticosteroids so I lied about my history and successfully avoid the unnecessary procedure. :)

leokid said...

teringt masa nk buat hiv blood test kat sini masa awal semester dulu. kitorg kat sini kena buat hiv blood test every year kt local hospital.

nurse tu nak kate x pro..nmpak mcm dah berumur. huhu. my vein kat tangan kiri agak halus/kecik. so memula tu dia cucuk, tak kena. while the needle still ade kat dalam skin, dia pusing2 jarum tu nak navigate bagi masuk dalam vein gak. T_T still x masuk2 lagi. last2 dia keluarkan balik jarum tu, pastu cucuk balik kat area tu. adeh..

kat sini doctor/nurse/medical job not as "holy" as kat malaysia.. gaji diorg kat sini pun cikai giler. takde org kat sini nk jadi doctor atas sebab nk $$$. Tambah pulak style kat sini doctor x prescribe medicine, so x byk private practice. Sebab tu agaknya diorg x brape appreciate kerjaya medic ni. Buat kerja pun ala kadar, nak kata sambil lewa tu tak la tapi still boleh improve a lot.

But looking from the bright side, keadaan camtu menyebabkan masyarakat kat sini well-educated pasal bidang medicine ni. Nama2 ubat semua diorg tahu. Something wrong in either treatment or diagnosis, diorg boleh detect, siap boleh tegur doctor lagi.

leokid said...

*eh silap, 2nd paragraph. doctor kat sini just bagi prescription je, pharmacist yg bagi medicine.

NMZ said...

to dinousar:
wil comment u on next series. I do think u did the right thing ;)

to leOkid:

Samela ngan kes as, nurse tu senanya nampak da senior. Heh, sian kamu. Da many times as kena camnih. ;p

Kat msia, Dr just bg prescription and pharmacist yang bagi ubat. Sama la kan, ke camne maksud Kid? Huu..

Dulu kala dgar cite Msia antar students gi Russia sebab Russia ni bagus bab sambung anggota badan, ye eh? Ke mitos? ;P

Pasal layman kna ade knowledge pasal ubat2 neh, will comment u on next entry. :)
memang 'bright' betullah kalo camtuh

leokid said...

Takdela i mean kalau macam kat malaysia,

1. Hospital kerajaan: doctor prescribe ubat, patient pegi ke unit farmasi amik ubat dari pharmacist.

2. Klinik swasta: doctor prescribe ubat, beli ubat kat klinik dia terus.

3. Pharmacy swasta: jual ubat2 tambahan, supplement, etc etc. Semua org boleh beli (?)

Tapi kalau kat sini,

1. Hospital kerajaan: Doctor diagnose, bagi prescription.

2. Klinik swasta: Doctor diagnose, bagi prescription.

3. Pharmacy swasta: Patient bawak prescription doctor, tunjuk kat pharmacist. Beli ubat dari pharmacist. Ubat2 tertentu hanya boleh dibeli dengan prescription doctor sahaja.

Russia bagus bab sambung badan? -_-" tak pernah dengar la pulak. Tapi kalau dari segi expert dalam bidang military medicine, mungkin la kot. Diorg kan byk pengalaman perang sana sini. In fact, kitorg akan ada satu subjek khusus "military medicine" time final year nanti. (tak tahu la kat tempat lain ade ke tak. rasanye ade je.)

NMZ said...

owh macam tu ke...thanks for the sharing..sharing is caring.. :)

by the way, tak sume ubat leh amik kat pmacy msia. Mcam biasa banyak la yang restrict. Kalo mc watson lg teruk, mcm ubat as sume die tanak jual selagi as tak bg prescription Doc. Huu..(memang takde pun..heh)

Thanks kid

Dr Kadir said...

Malpractice and negligence di mana-mana. Kat sini pun selalu jer berlaku kes-kes camni dan ada yang lebih teruk lagi sehingga boleh bawa kematian kepada seorang sahabat yang jugak student medic sini apabila lambat diberi rawatan untuk diabetic coma yang dihadapi. Kawan tu dah tahap critical tapi still lagi nak negotiate tentang bayaran dan deposit sebelum apa-apa rawatan diberikan.

Sedih pulak bila dikenang-kenangkan kembali. Yang kes-kes kecil pun banyak la juga. Moga doc2 and medical practitioner to be akan lebih celik dan prihatin ttg perkara2 camni.

Gud luck. Moga sentiasa dirahmati...:)

Dr Kadir said...

salam kembali,

Ha tadi jumpa sorang dr dari department radiodiagnosis, asked him about eihter its necessary to put off the scarf when a patient is going to hava a ct scan. Katanya yang nak kene tanggalkan kalau2 ada apa2 metallic materials pada scarf tu, ada pin ke, atau apa2 je yang boleh ganggu image yang akan terhasil. so kalau takda takpe je la... :)

NMZ said...

to Dr kadir:

Sorry to hear that, inshaAllah, future to be sume alert ngan benda2 neh. Dasyat tul..

Thanks for the sharing, memang time tuh takde bahan radiopaque(bahan yang halang pathology to be seen) on my scarf. Kalolah ade pin pun, kat leher kan? Takde kena mengena ngan brain. Hehe.

Tah papelah diorang nih...

sekali lagi, tak faham..

Anonymous said...

salam alaik

im sorry for your pain during the needle insertion.having said that,i really encourage you,or anybody else who's really keen on criticizing each and every move of a healthcare worker,to try to do venupuncture(cucuk jarum ke dlm vein) or cannulation yourself.having done it few times,and having failed once,i know how it feels when facing a patient with 'difficult vein'.yes its an easy procedure.its like a penalty kick.more often that not,you score.but there are bound to be times when you just cant score.when it does happen,blaming the penalty kick taker seems to be the most convenient thing to do.but imagine if YOU are the penalty taker yourself.u wont enjoy that sort of criticisms one bit.
and yes,if we missed the vein,we are advised to try to direct the needle from inside rather than outside coz we might be able to still get thru the vein from the side.its not like its fun hurting the patient but thats how its done in that situation.nk buat cmne...

hazadeen said...

assalamualaikum wbt..to anonymous n to tuan punye umah..hu~

harap2la this sorta entry will lead to a better future in Malaysian Hospitality..bukanlah sbg medan perdebatan antara future medical officers n their respective patients in defending their opnions..naudhubillah..

plus, pointing a blaming finger never get us anywhere aite??hee2.so apa yg kite leh wat is just to take d iktibar from tis experience n try to understand one anothers' roles well..then,hope that it'll lead us to a better understanding between docs n patients..empathy is d key here,ok??hehe

first seek to understand, then be understood..muga kita suma berada dlm redha n rahmatNYA..ameen

p/s, simply LOVE d Malaysian Hospitals Series..huhu~

NMZ said...

To anonymous:
Thanks for coming :) First and foremost, I understand your intention. Because I am also a healthcare personnel to be. My apology if this hurts you.

Second, I also have my own intention and I would like to invite you to read the post entitle declaration on MH the series. Which there I've stated why I did this series.

Surely it is not to critique others, because Im gonna be one of them. In realizing that, I have my own mission to contribute a bit, for all healthcare personnel to be, to know a bit what kind of condition they will face, and try not to give EXTRA harm to patients.

My word here, not giving EXTRA HARM, means, a small harm is normal, what kind of procedure yang tak sakit, kan. Thus, just no additional harm.

For this 3rd series, the vessel is obviously seen and I already pointed at the right part, but she insert at the other part. That's why I cud not understand why she dis not insert at the vessel which is obviously seen. This all cud be avoided, aite? And know what, she took more than 1 minute to direct the needle from the inside. Left and right, left and right. Hehe.And Im not a patient with 'difficult vein'.

I understood, in certain cases yang patient punye vessel memang halus and susah nak nampak. Dah nampak pun bile masuk still tak kena. But my case is different, and I simply explain all of them in the story, to make all of you understand why I am writing it. Only if you read dengan teliti..

My simple point here is, it wasnt to critique anyone, but for sharing. Memang bukan senang cannulation ni, it wasnt any easy, but the sense of confident and trust will help at least a bit. Try to read the story again to understand why.

It was my mistake for not writing in details on the condition, my apology. Yet thanks a lot, I will watch my step in the future.

To all readers, it is not a field to finger pointing to anyone, cuba berlapang dada, amik yang baik, tinggal yang buruk.


to hazadeen:
InshaAllah, there's no need to have a debate on things. But intellectual discourse if preferable. I wud like to hear other's opinions especially those yang more experienced in this. And also from the beginner, not forgetting the layman (orang awam). Different critiques wud be nice.

I wud love the empathy as the key, as I've stated earlier in my declaration. Having the experience as healthcare personnel also as a patient, I will write my view based on this and I am open for any reasonable critiques.

Try to understand others, hence others will understand us. InshaAllah.

Apa yang baik dari Allah, yang buruk pun dr Allah tetapi disandarkan pada diri saya. Mohon maaf untuk itu, moga apa yang tampak buruk, ada hikmahnya. Try to look at the bright side.Moga setiap yang dilaku dalam redhaNya.

wallahu'alam

Anonymous said...

Nurilahi:

1. Somtimes tudung disuruh buka to avoid any re-take/re-scan incase ada radio-opaque material.Thus will contribute xtra dose.
Scarf unnecessary.
But i agreed with u,plz be more concern + consider pt dignity.
2. Kindly double check,sure onot barium used in iv contrast media. AFAIK,it onli used in examination such ad BaSo4 studies.
3. Thanks for ur story and ur pov,buat hamba muhasabah diri.

nurilahi said...

dearest anonymous:

1. no radiopaque material on my scarf dat time, already been removed (:
2. corrected tqvm tak pasan :D ngeh3
3. terima kasih kembali... :)