I walked into the general medical ward in a bright June morning as a young trainee neurologist to start my round. My residents and house officers were there before me and were keen to get the round over and done with so that they can carry on with the rest of the ward work for the day. I spent a grueling three hours on my feet listening to the residents telling me the story and examination finding of each of the patient – with the young houseman scuffling up and down to bring me results and x-ray films.
Towards the end of the round, I came to this lady in her early forties. She was lying curled up in her bed, even without completing my neurology training at that stage, I could tell she was obviously in vegetative state. She was put in a corner of the ward, and was surrounded with a fold-up chair with long back rest – one that could open up long enough for an adult to sleep in – and little shelves full of books. My instinct told me, the more things there are surrounding a patient, the more the family cares about the patient. The patients with an empty bed table are those without visitors or family. Obviously, someone is spending a lot of time beside this vegetative lady everyday. The nurse looked at her watch. It was nearing lunch time; my round had started at 8 in the morning. She hurried me on by saying, “Don't have to see her, doctor. She's been here a long time. All the other doctors just passed her by.”
My curiosity was aroused. “Tell me her history,” I said to my resident. I saw beads of sweat on his forehead. “Err... she's been here a long time. I will need to dig out her notes to find out exactly what happened to her.” He then hurriedly added, “Well, she is not for active resus. Just for palliative care.”
I looked at the nurse, who had worked there for a few years. “She was a staff nurse here. Something like 12 years ago, she suffered an asthmatic attack and was complicated by hypoxic brain injury. She's been vegetative since.”
“Oh,” I said. I walked toward her and did a quick physical examination. Well, after 12 years she had no bedsore, and no other complication such as pneumonia or urinary tract infection. Someone must be looking her very well. But the mouth was atrocious, full of caries.
“Can we refer her to the dentist?” I told my resident. He was only too happy to comply to get me moving along to the next patient.
The next week, when I came to do my round again, I saw him there. He was in his mid-forties; slightly bald at the front, wearing an old fashion square pair of glasses, and was staring down at his shoes shyly when I walked in. He hurried out before the nurse asked him to. On the way, he looked at me briefly and said, “Thank you doctor. You are the first one who looked at her and asked the dentist to see her.” He said sheepishly.
“Don't thank me. I'm just doing my job.” Feeling slightly embarrassed, I moved on without saying much. Twelve years and no one bothered to look at her mouth, we weren't doing our job.
“Have you found out about her?” I stared at my resident.
“Err..., the record stretched back too long.” My resident said nervously. “Apparently, she had a long history of asthma and came in through the Accident and Emergency Department one day. Somehow ended up having a bad attack that caused her to have hypoxic brain injury. She's been here since.”
Nothing I didn't know. Obviously, too, my resident had not examined her thoroughly.
“What about family support?”
“The family support is excellent. The husband comes once or twice a day just to spend time with her, sometimes reading to her. He will come after the morning and the evening round so as not to disturb the doctors.” The nurse chipped in to help the resident. That also explained the little library and the chair besides her.
“What? For the past 12 years?” I asked with an incredulous tone.
“Yes, doctor. We often see him. He does not stopped even during festive days.” The nurse added.
Since that day I have noticed him walking in and out of the hospital. He had stayed faithfully besides his vegetative wife, contended to just spend time with her even though she could not reciprocate at all. Contended with just her presence, just the mere fact that she was still around to be with. Whenever I was put in charge of the general medical ward I would see him around, sneaking in quietly after I finished my round, as though he was afraid to be chase out of the ward for spending too much time there.
Having finished my training, I have not been back in the general medical ward for quite awhile. A couple of years ago, I stopped seeing him around. Curiously, I went up to the general medical ward and asked what happened to our longest stay patient.
“Oh! She passed away.” The nurse remarked, plainly and emotionlessly, as though commenting on the weather.
I have not seen him since. But his shy and sheepish look burned deep into my mind.
