My father-in-law

It has been a trying and tiring two weeks for my wife and I. We have been popping in and out of the Bukit Mertajam government hospital, usually twice a day but sometimes more often, to look after my warded 87-year-old father-in-law who was - and remains - in critical condition. 

It all started on the 26th of last month. Shortly after 11 o'clock, she received a call from her brother to say that their father had breathing difficulties and was being taken to the KPJ Hospital. So we rushed there to meet with the rest of the family. My father-in-law was outside the emergency ward while the hospital tested him for any possible Covid-19 infection before admitting him. But then the medical officer in attendance came out to say that there were fluids in his lungs. "He might have to go into the ICU ward," the MO said. And then came the million-ringgit words of caution. "It's going to be very expensive here," he said, "costing about RM10,000 per day or more" without knowing how long he would need to be there or the procedures that the hospital would do on him, before suggesting that he be taken to the Seberang Jaya government hospital instead. Maybe we were wrong but the impression we got was that the private hospital was rather reluctant to accept him. 

But then, my nephew who is a private medical practitioner himself said that between the two nearest government hospitals, if we wanted to ward him in one, the Bukit Mertajam Hospital would be a better bet as it had all the facilities and was nearer our homes. Thus, we decided to transfer him from the KPJ Hospital to the Bukit Mertajam Hospital. By this time, it was way past one o'clock in the morning of the 27th of June. We waited until about 3.30am before going home after getting an assurance from the hospital that he would be warded as soon as a bed became available. The next day, we found him in the hospital's Ward 8, relatively conscious of his surroundings but still very weak.

The problem with my father-in-law is that he has so many medical problems: diabetes, high blood pressure, high cholesterol level, prostate enlargement and a two-time stroke survivor which left him no choice but to use a walker in recent years to move around the house as he has difficulty coordinating his left leg well. On top of that, he started to develop dementia several years ago. People used to call it senility but we know it now as dementia: a state of confusion and an inability to remember recent and present events but remembering events from the past well enough. That's why in my brother-in-law's house, he wakes up at odd hours to check that all the doors were properly locked. That was his habit when young. When he was a bit healthier, he even checked on the front gate. And this, he would attempt several times in the middle of the night. It was a toll on my mother-in-law.

Since late last year, we have seen him getting weaker. Eating less and getting even less mobile. In the last two months he even fell when he couldn't coordinate his feet properly despite using the walker. Once, he injured himself badly when his head hit the walker's bar and gave himself a black eye! 

So he was now in Ward 8 of the BM Hospital. Initially he was strong enough to stand up by his bed which alarmed the ward nurse enough to restrain both his hands. But funnily enough, he was able to use one hand to untie himself. Until we saw it ourselves, we wouldn't have believed it if someone else told us. But he remained very weak until he couldn't even prop himself up on the bed and had to be helped by us when we visited. Worse still, he couldn't eat much. If we weren't there to help feed him, I doubt he would have gotten much help from the ward nurses. Yes, they claimed to have helped feed him but I very much doubt he ate much. Let's face it, there are so many patients in the ward and only a small number of nurses. How much undivided attention can a nurse give a patient? Moreover, the weaker he became, he more he slept. And he often slept past meal times. During visiting hours, we had so much difficulty getting him awake to feed him.

By the time the hospital moved him to Ward 11 on the topmost floor, he had become so weak and continuously in a deep sleep, and only occasionally opening his eyes for a few seconds before falling asleep again. Seating up was out of the question, let alone to stand by the side of the bed. We tried to ask some questions of the nurses in this ward but they weren't helpful at all, unlike the other ward. Their attitudes were dreadful. Where's the caring? Are they so impervious to the worries around them? I think to them, nursing is just an unpleasant job that brings good money home. They were certainly no Florence Nightingale. There was one whose eyes glared fiercely if you tried to ask her too many questions. I wonder how they could live with their conscience at all. We also tried to consult the doctors but our attempts proved very difficult. There were days when the doctor came on their rounds only once a day, attributed of course to those days being public holidays or the weekends. We were told that there was only one doctor working during the holidays and they had to attend to all in-patients and also including the emergency ward. Maybe my father-in-law was unfortunate enough to be hospitalised at a time when the country had too many public holidays. (Conclusion: Perhaps people shouldn't dare to fall sick during public holidays!!) But yes, I acknowledge that we did finally get to see the doctor at the end of the day. The prognosis was that my father-in-law's condition was not going to improve anytime soon if at all. He is sliding down the abyss with each passing day despite all the medication and tests run on him. His kidneys are failing him and with it, I fear his other organs will start failing very soon. Since my wife's family had already preferred him to rest at home and spend his last days, we stayed back yesterday to request the doctor to discharge him. The doctor said she would still like to run one or two tests on him but on a more personal tone, she agreed that taking him home might be a better decision. She started the paperwork at about 6.30pm and by 8pm, we had already received all the medication from the Pharmacy. I then arranged for a private ambulance to bring him home to my brother-in-law's house in Bandar Tasek Mutiara. He's there now, resting comfortably and surrounded by his other loved ones, but quite oblivious to all the attention and danger to his life. We are now arranging palliative care for him.

As an after-thought, I want to repeat what I told my wife a few days ago, and that is, in my opinion there is never a right or wrong decision when it comes to deciding on a final course of action regarding the life of a loved one. Never live with the doubts of whether your decision was correct or incorrect. I've experienced it with my father in 1996 and my aunt in 2013; I had to make two of the hardest decisions in my life. My father too had to make a difficult decision regarding my mother in 1985. Our conscience must be clear one way or another because we are simply the facilitator of an action. The patient's own kamma had already pre-determined the direction. Only when we accept this can we be at peace with ourselves.