Monday, March 28, 2011

appreciate life people!

sehat itu mahal. tp kadang org jg tdk bersyukur saat msh dikasih kesempatan utk memperbaiki kesehatannya dg diberi penyakit. i know, getting hospitalized nowadays cost a fortune, especially if you wanted to get the best care from the best specialist. biarpun ada asuransi, tdk menjamin semua akan ditanggung pihak asuransi.  let me use an example.

several months ago, there was this patient, an 80 yrs old woman, looked humble in ICCU. which is a rare view in our ICCU. out of curiosity, we asked her, since according to her record, she'd had a stent inserted in her coronary artery which cost her more than 70 million rupiah. we're not underestimated her, but we just curios since most patients, especially the uneducated ones, refuse to get a stent when they found out the cost. she told us that she only had 2 kids, one son and one daughter. her son opened a garage near their home. while her daughter was a worker in some factories. since the regulations in most factories never cover any family member if the worker is female, we wondered where she got all the money to pay for the stent. but i guess, her children could manage to get it so she could get the best care.

while couple weeks ago, a 56 year old male, a cook from renowned hotel in Surabaya being hospitalized because of heart attack. we caught it early and we offered to do angiography and probably a stent since it was the best therapy for him. the management from the hotel agreed to do it as long as it is necessary to safe his life. but the added cost for his care will be discussed later after he's being dismissed. when he heard that he had to pay any extra cost for his care, for more than 10 millions, he refused the angiography and prefer the streptase which is cheaper.

from this two cases, i found out a different decision. probably both families didn't have much money. but the first one, manage to find a way to collect that much money so their mother could be treated to the best and get the best result. while the second family, even though he's still working and probably he could save and pay the management a little by a little, but he refused it. i don't know if he had other debt or any other consideration that made him refuse the angiography that time, but compared to other family, i wonder, why he couldn't manage it? padahal lek dilihat, dr luar tampak lebih mampu keluarga kedua drpd yg pertama.

and he seemed like ignoring God's warning. stl serangan jantung, apalg dg hasil yg seperti itu, harusnya dia ga blh kerja berat dulu. but only after a week, he got back to work. i don't know. kadang orang2 seakan nggak mengerti kalau mereka itu msh disayang Tuhan. masih diberi kesempatan utk memperbaiki hidup. masih diberi nyawa sambungan. dan makin sebel kalau ternyata org tersebut malah memperburuk keadaannya dg tidak menaati aturan rumah sakit dan malah seenaknya sendiri.

Tuesday, March 8, 2011

RIP: Mrs.S

RIP. i might be cruel for predicting her fate before it became real. but watching her record, she will eventually dead sooner or later due to her stubbornness. and it became reality this morning. she came back to ER too late. she had been died in her house only God knows when. her family rushed her in to our ER, but it was too late. they couldn't do anything.

pretty sad though. they had money. they had the chance to get her better. but every time we suggested this and that, they always refuse.they always bargain. i know, as a doctor, probably we should push them to obey our advice. but as human beings, we couldn't force them to obey us. and there's a freedom of choice. they chose not to obey our advice, so as the same human being, we have to honor their choice. too bad though, because we knew that their choice is wrong. we, doctors, we knew better what's best for them. but we should try our best to make them understand it.

but once again, only God can do miracle. even though we have tried to convince them, we might fail. only God that can influence their decision. we could only try our best. perhaps, yesterday i wasn't try hard enough. perhaps i should force her to stay in the hospital. perhaps i should scare them, so they didn't bring her home. but again, they made their choice. they had choose her fate. she had choose her fate. may her rest in peace.

Monday, March 7, 2011

dilemma

sekarang aku jd menyadari, jd dokter di masa ini susah. we're facing a new problem. educating people about health prevention and helping them to be aware of their symptoms. but then it backfired at us. kadang ada beberapa org yg psikosomatis, malah memanfaatkan ilmu yg kita berikan ke mereka sebagai keluhan dan they can mimic the symptoms so we doubt whether it's the true symptoms or not. bbrp malah terlalu panik sehingga tiap keluhan muncul dijadikan masalah besar dan minta perhatian sesegera mungkin. even though we've explained that it's not emergency, they couldn't understand it. more over, they are people with money, so they think their money should get our attention to give them priority.

but talking about money, i realize that people with money, they all very demanding. some demand priority, assuming that money should give them priority. some obey our rule and instructions, but others disobey us, thinking that they're smarter than us and they can instruct us which medication they would follow and which is not. this is ridiculous.. kita para dokter terancam hukuman jika kita melakukan malpraktek. what if, malpraktek itu terjd krn mereka yg keras kepala? tidak mau menuruti segala instruksi kita dan menganggap kita ini berlebihan? dan nanti pada saat yg kita pikirkan itu benar, mereka balik menuntut kita dg kelalaian?

meet mrs. Sul and her family. she suffered chronic kidney disease. since the first time she's been diagnosed, the doctor has instructed her to do hemodialysis.but she refused. she bargained. she just wanted the diuretic injection. from time to time, every time she had difficulty in breathing, she would go to ER and quarreled again with us, refused to be admitted to the hospital and then ended up going home after being injected with diuretics. and one day, the diuretics couldn't help anymore. by the time she agreed to do the hemodialysis, it's already too late. the access to her iv were a mess, so we couldn't do it. we had to consult to a vascular surgery to insert a trilumen. Then before she had the dialysis, she couldn't breathe so we intubated her. after few days in the ICU and then regular hemodialysis, she's still stubborn.

AV shunt didn't work out. her trilumen is not working either. so she got no other choice. she had to get hemodialysis, but no access to do it. the other option is CAPD, but then, it couldn't be done soon. she refused to be admitted, but her physics couldn't hold longer. the family didn't help either. they blamed us for not cooperating with all their demands. as institution, we're held back by regulations and protocols, tapi mereka seakan memutar balikkan semua peraturan sehingga terlihat seakan kita yg tidak berperikemanusiaan. mereka yg menolak segala terapi, mengatur semua tindakan, menolak semua anjuran dokter. if i wanted to be rude, aku bakal bilang ke mereka "kalo gitu ngapain ke rumah sakit? kalo minta ditolong, harusnya nurut semua. kalo masih ngatur, ya obatin aja sendiri"

and now his husband cursed me for being cold-blooded doctor. he's the one that still hardened his heart and chose to comply his wife and brought her home despite her breathlessness. aarrrgghhh...what a stubborn, rock-headed family. abis gitu masih nyalahin semua orang. perhaps it's the curse from the nurses back in ICU. krn mereka selalu menyalahkan kita dan terus tidak mau kooperatif dalam tiap tahap terapi, akhirnya para perawat yakin, she wouldn't survive. bukannya kita mendoakan dia meninggal, but according to our record, people like her and her family, ended up dead because of their stubbornness. let's see whether or not she will survive. may God give revelation to her and her family.  

Wednesday, March 2, 2011

ER dilemma

ini akibat peran dobel, jadi anak pendeta sekaligus dokter jaga. nasib..nasib... dulu awale bingung gimana hrs bersikap lek ngadepi pasien jemaat. apalg kalo mereka2 jemaat lama seng kenal aku dr kecil. bingung gimana ngadepinnya. lha wong mrk udah kenal aku dr jaman masih imut2 dulu, dr masih mbrangkang, ampe skrg udah seperempat abad. rasae sungkan ae kalo aku kudu mengedukasi mereka. mereka lo tau mokong2e aku gimana pas kecil..trus skrg jd dokter yg meriksa mereka... hmmm..lek aku jd mereka aku dewe jg bakal merasa.."ini kan anak ko den yg dulu msh selutut..eh..skrg udah jd dokter.. " rada separo ga isa nyalahin lek mereka ga mau takperiksa atau ga percaya..

tp lama2 aku bonek aja. sok pede kalo ada jemaat. lama2 mrk jg udah biasa. biarpun kadang msh ngeledek "bu dokter" tp aku cuek2in aja wes. soalnya resiko kalo diliat pasien lain, ntar mereka kira aku ga pede. masalah yg itu beres, tp muncul masalah lain. soal fee. di satu sisi, sebagai makhluk Tuhan yg masih normal, siapa sih yg ga butuh duit? even a pastor's daughter also needs money. wekekekeke... tp di sisi lain, masa anak pendeta ga beramal? narik duit dari jemaatnya sendiri?? errrr... aku jd bingung. akire aku membuat keputusan sendiri. SK ala eunike. ehehhehe... kalo mereka baru pertama kali takperiksa dan emg kenal deket, takgratisin, apalg kalo ga mampu. tp kalo yg tajir2 trus ga kenal2 amat apalg kalo recordnya nyebelin, ya bayar aja deh.. wekekkeke.. anggap aja persembahan, hahahahaa...

tp masalahnya adalah, tiap aku menihilkan honor dokter, bagian counter tuh mesti nanya. kalo alasane krn jemaat terus, jangan2 ntar malah ga boleh dinihilin. guawat dongg..secara jemaatku kan banyak tuh. repot nih. apalg pas kmrn jaga malem. entah knp seakan jadi hari jemaat sedunia. dateng2 udah ada anake tiky yg mo nebul. abis gitu tengah malem ada cucue bu umar 2 orang. haiss.. akire yg cucue bu umar takksh buy 1 get 1 free.. wakkakaa.. soale pasienku dikit..lek digratisin semua, aku gigit jari. lek ga takgratisin, wong bu umar itu baik ama mami...serba salah. akire buy 1 get 1 free ae wes. pagie juga gitu, ada mas2 nyerempet ibu2. krn perawate juga sakno, akire rawat luka ama honor dokter pun dicharge buy 1 get 1 free. obate jg takksh yg murah2.

nah, urusan fee udah ada SKnya. skrg urusan lain. sometimes, even though they are my congregation member, sometimes they could be pain in the ass. mulai dr yg minta diutamain, ampe yg ga nurut lek disuruh ngurus admin. sebel deh.. perawate jd keki. aku jg sungkan. krn di satu sisi aku kenal mereka, tp krn mereka ga kooperatif, aku dewe jg ga enak ama perawate. grrrr... kalo udh begini ini..bayar aja deh. biarpun kasihan, tp kalo annoying ya males bgt ngeladeni. aku dewe jg kalo mereka komplain, selama masih masuk akal ya aku ladeni. tp lek wes ketok mrk yg kenemenen, mek masuk kuping kiri keluar kuping kanan. masa bodo amat aku dirasani di belakang. kadang aku jd risih sendiri. mereka lo jemaatku, tp ternyt kalo di luar they act bossy and stuff, pdhl kalo di gereja they act like they need help, especially in economic. grrrr... jd pengen marah kalo liat begituan. *sigh* ya udah lah.. namanya jg manusia... diterima saja....

Tuesday, March 1, 2011

not a good way to start a new month

i'm starting this month with a lot of questions. not a good way to start this month actually. i'm starting to doubt my life. all my choices so far and i don't have answers to my still-hanging-future. i don't even know why am i so pessimist this time. i don't even know me anymore. i'm different from that girl years ago. i was a med student, with a lot of spirit to be a good doctor and to save lives. and i had hope about my study even though it's hard .i had a lot of plans, going to AZ to get a job and then find a school. or going to PH and study there. i don't even worry about "ujian persetaraan" which i had to take afterward. i don't care all of that because i  belive that when i finished my study, there will be a lot of international hospital, so probably aku ga perlu lagi ambil ujian persetaraan. i even think getting paid by dollars.

but now, everything seems falling apart. i thought, after i couldn't go abroad to study, i can still study here. so i think UI is a great choice because they are still fair until this time. choosing cardio especially. aku kira aku bakal berjuang habis2an, ketrima ndaknya ya itu nasibku. at least i don't have to spend a fortune just to get me back into the med school and scratching every penny along the process. but i think God has different plan for me. jadwal ujian UI bareng ama tanggal lamaranku. okay then, i thought perhaps this is God's speaking for me to pay attention, like He tried to say "kurang jelas ta?"

back up plan is pleasing everybody by trying Unair. i don't like the idea of going back to Unair, especially when i've already knew what i will face once i'm accepted. and perhaps because of that, everything is a mess right now. penundaan PTTku bermasalah, pendaftarannya juga ga buka2. right now i'm in the middle of nowhere. semuanya ngambang dan itu merantak jd masalah lain. kalau penundaan PTT sekarang bermasalah, ga menutup kemungkinan akan bermasalah lagi di kemudian hari. because of that, i decided to give my full time work at mitra to get a job in a clinic yg bisa dihitung sbg PTT cara lain. well, as consequences, my salary won't be as much as before. and it took 3 years to complete it. and probably, even though i can get it now, mungkin aku ga akan bisa langsung daftar periode ini. worst case is i apply after wed or next year. yg berarti molor lagi. belon lagi masalah ACLSku yg bakal expired taon dpn.

right now, i have no idea what to do with my life. i started to question everything. is this really what i want? i wasn't this person a year ago. am i giving up too much? or is this what i've become now? i'm starting to doubt my decision. choosing you for instance. is it the right choice? somehow, i want to do a measurement. what have u giving up since we're together? since i felt that i've given up so much. i know, it's all my choice, my decision. that's why i'm questioning me right now. and i don't know how to get myself back. i hate realizing how vulnerable i am right now. i cried more than i used to, and i hate that i had to depend on u most of the time. putting my life on line. or is this some kind of exchange? i never dream about getting married and here i am, in the road of being married. i always dream about being a hard-ass doctor, no matter what specialist i chose, but here i am, in the road of nowhere being a specialist.