Sunday, August 24, 2014

Thailand Medical Adventure - 5 - Tha Muang Hospital Pharmacy, Dr. Mai and Unexpected Sadness

The songkran fun continued.  On Friday I was coming back from the hospital to my hospital bed apartment =) and heard this high pitched Thai music blasting from the courtyard.  I assumed it was an ice cream vendor or something.  I walked around the corner and there was a rainbow of Hawaiian shirts and about 50 people holding flowers, steel cups of water, and face chalk.  The heads of the hospital sat in a row and individually the staff were pouring water on their heads.  The moment they saw me, I could not escape haha.  Smiles, sawadekup, and before I knew it my face was covered in the wet chalk paste.  They lead me to front of the line, gave me water, and flowers and I was right in it pouring water on the head of the hospital that I had met just yesterday!  Haha. Can you imagine doing this to Dr. Feinberg the head of UCLA health system.  So crazy.  A few minutes later, shouts, shrieks, and a water fight erupted!  Like, personal attack style. Buckets on heads, unsuspecting administrative staff and nurses.  Was madness.  I decided to get away and head to the pharmacy since I had heard they were interested in meeting me =D.  I arrived and met Eoit.  She is a pharmacist with some English skills and just a glowing lovely lady.  She showed me their formulary, which was quite open and easily accessible with little labels.  Attached are the photos of some of their medications used.  I kind of felt like a kid in a candy store.  There is something fun about seeing all the medications, holding them, and walking from row to row.  There were random medications I had never heard of and some that have fallen out of favor in the US.  See pics.







While I took pictures of the racks, I see an unassuming yet totally drenched pharmacist walking around with a bucket of water… Shriekkk.  SPLASH.  The head pharmacist poured a bucket of water on the pharmacy tech right in front.  Haha.  Madness erupted again.  People hiding in the bathroom, buckets of water flying, meanwhile patients wait patiently for their medications!  Haha. No one seemed to mind.  Computers, medications around, not a problem.  The carefreeness was wonderful.  Once again I was attacked with chalk paste.  They seem to like to do that to me.  I was able to pull the “I have a cell phone” card and they didn’t pour water on me.  What craziness and fun.  Might need to try this out in the stiff medical system in the US haha.  Honestly, life is too short, might as well have some fun and relax the rules from time to time.







------------------------------------------------------------------------------------------------------

On a separate and very sad note, to add to the pool accident that occurred recently, Dr. Tip told me that the long-term boyfriend of the staff Chinese Medicine Practitioner, Dr. Mai, was shot in the head just a couple days prior.  It occurred on an evening of Songkran at a Thai nightclub called the Buzz, not far from the main Kanchanaburi city road with all the tourists.  It seems to be either a personal attack or accident (wrong person attacked), either way it was catastrophic.  I was told he was in a coma in the larger kanchanaburi hospital in the neuro ICU.  I had met Dr. Mai when shadowing her clinic (more about the TCM and complementary and alternative medicine at Tha Muang later).  She asked if I would be willing to visit her boyfriend, Bank, at the hospital.  Of course I accepted, not sure of what I might be able to add to the referral center neuro ICU care. 

A little about her, Dr. Mai is an amazing individual.  She is so dedicated to her patients, and even was working soon after the attack.  She is graceful, caring, present and just a wonderful human being.  She is originally from Trang and is Muslim.  It is so sad to digest this horrible situation.  Bank is from an affluent highly regarded family in their village and he is an engineer that was running his parents factory. His family is Buddhist.  ......  And all of a sudden, he is gone with one pull of the trigger....

I was picked up by Dr. Mai and her mother, whom lives with her.  We drive to the Kanchanburi governmental hospital.  Arrive at the NeuroICU, and there are shoes along the way.  We take off our shoes and walk barefoot inside.  That was a first for me…  Apparently it’s for all the ICUs.  We walk up to Bank, surrounded by maybe 10 family members holding his hand, touching his legs.  The families eyes move to us and specifically me.  I meet his mother, father, brother, aunt, cousins, and friends.  The sadness is palpable and a river of pain just below the surface of everyone.  Bank was completely unresponsive, with bandages over his right orbit, and skull from the injuries.  He was intubated and not sedated, without signs of distress.  Dr. Mai grabbed the chart and showed me the CT scan + report.  It became apparent that the prognosis was extremely poor from the trajectory of the bullet, and multiple other factors.  It was just so sad, I had to keep biting my tongue to keep it together.  Bank’s Mom asked me how her son was doing… Such a difficult situation since I am not the ICU attending or anything.  I did my best to explain the significant trauma to his brain and tenuous status, but to continue hope.  I tried my best to explain the images and radiology report to Dr. Mai.  She had already spoken to the supervising attending and understood that he was in a deep coma with very limited chance of survival or any meaningful recovery.  Before leaving, Bank’s mother invited me to her home for a traditional Thai meal in a couple days, since she heard I enjoyed green curry.  I accepted, but did  not know if she wanted time just with her family, but she insisted.  The next day I stopped by Dr. Mai’s clinic and found out from her student Cheer that Bank had passed away just a few hours ago.  Just so sad.  It was inevitable from the images but still upsetting with how rapidly he passed after our visit.  I read that almost 90% of gunshot wounds never even make it to the hospital alive, so at least he was able to remain alive for about a week to be with the family and Dr. Mai.  The bullet was retrieved from his brain for the continued investigation by the police, which seems very difficult given the large number of guns I heard are owned in this region. 

A couple days later Bank’s mother invited me visit her Resort before his funeral.  I am not used to such welcoming during a time of mourning, but of course accepted.  We first visited their family home which was a flurry of activity with community members preparing large quantities of food for the family and friends attending the funeral.  Beautiful traditional flower arrangements (in a large circle, with set patterning) were set up all around the estate.  We drove to the Hatchery, the name of the family resorts, which is a beautiful boutique hotel with restaurant, fire pit, with picturesque landscaping, small pond, and right along the river.  It was so peaceful and quite.  I was almost speechless, nor did I know what to say to a grieving mother, girlfriend, and other family members.  After some time we headed back for the Buddhist funeral proceedings.  I have been only a few funerals, and mostly Christian and Jewish.  This was very different.  They had a schedule of the ceremonies over the week that seemed to occur twice a day.  The monks at the local Watt (temple) ran the ceremony.  Many of the doctors and dentists arrived and we sat together.  Dr. Tip explained that the chants are in Sanskrit which most Thai’s cannot understand.  But she said they know the meaning, which is actually a Buddhist teaching about the nature of life and the world.  After the ceremony, the hundred or so people received a bowl of soup.  We went in front, removed our shoes and placed an incense in a sand pot placed in front of the many flowers, a picture of Bank.  It was a beautiful ceremony and I wish I could learn more about the teachings.  We parted ways and I headed off with some of the interns for a late night meal before retiring to my apartment at the hospital.  After the ceremony I have been able to spend time with Dr. Mai and her mother who spends the whole day at the clinic with her.  She continues to see her patients despite this time of mourning and is truly a testament to her deep care for others.

No comments: