Wednesday 22 June 2016

A Family Medical Emergency

You realise just how fragile life is when a loved one who just a week ago seemed healthy and full of life is suddenly in ICU having just undergone an Aneursym Embolisation procedure. In simple terms, an "Interventional Radiologist guides a long tube called a catheter through a small incision in the groin up to the location of the aneurysm. Through the catheter, the radiologist places many soft platinum coils into the aneurysm. The coils are extremely small and soft. The body develops a blood clot around the coils. The packed coils and the blood clot effectively prevent blood from entering the aneurysm, essentially eliminating the risk of the aneurysm rupturing." (This is an excerpt from

A picture of what endovascular coiling looks like. Taken from 

Yeah, my sister has a brain aneurysm! I kind of know what it is but really don't know exactly what it is. I knew that it had something to do with vessels in the brain and the horrors stories of people dying within minutes of a ruptured aneurysms came to mind. Since then I felt the driving need to really understand what it is and how my sister could come out of it alive and well.

Typing "aneurysm" into Google yielded 9.2 million hits. I just clicked on the first hit which was WebMd and they had a topic overview that was very helpful for a non-medical person like me. Copying a small the excerpt from the article:-

What is a brain aneurysm?

brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysmcauses no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke.
When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death may result.

You can read the full Topic Overview here.

This just happened last Thursday, my sister was on a scuba diving holiday with her family in Redang Island. For as long as I can remember she always had incidences of bad migraines causing her to become nauseous and vomit. But she would always feel better after some vomiting, downing some pain medication and going off to sleep. Little did we know that it was an indication of bigger things happening in her brain. Two days prior she was experiencing excruciating migraines that would not go away and caused her extreme discomfort and nausea. They were actually due to come home to KL that day but my brother-in-law found her slumped in the toilet. She had blacked out and on the way down she must have fell face first on her right side, as she had a terrible black eye, swelling and bruises on her face and all along her cheeks and chin. She also had petechiae all over her face and neck.

They then quickly called the doctor from the neighbouring resort and he immediately recommended that she be transferred to the Kuala Terrenganu Hospital as soon as possible. A speedboat was then arranged to transport her to the mainland and then by ambulance to the hospital. They did some test and found that there is bleeding in the subarachnoid space and most probably would require surgery. They did a CT scan and a angiogram. They found the aneurysm but thankfully it was not actively bleeding. However, the risk of a potential rupture was imminent. As with all aneurysms, it is a ticking time bomb that could go off at anytime causing irreversible damage!!

A cerebral angiogram was needed but they didn't have the necessary equipment in Kuala Terengganu. Hence, the doctor wrote out the transfer to KL General Hospital at about 4 in the afternoon. Unfortunately my brother in law was then informed that they would only be able to do the transfer at 8 pm due to the fact it was the fasting month and they had to break their fast at 7 something in the evening. It was really a shock and inconceivable that a life of a person was worth less than someone breaking their fast and getting something to eat. It really begs the question, could they not break their fast on the way? Surely our newly built fantastic and equipped highway could provide a place and food for them to appropriately break their fast during this holy month of Ramadan. Ironically, the virtues were just not seen at all...They waited from 4 pm till 8 pm and when nothing happened my brother-in-law had to go once again to ask if the transfer was happening and he was then told, that the people still had not completed their meal and would be back soon. The possible rescheduled timing was 9 pm. Once again more delays and what was worse, they could not even be bothered to inform anyone about the change of time. You could just be sitting there waiting for nothing! At 9 pm, my brother-in-law had to once again ask the nurses whether the transfer was happening or not only to receive the answer yes, BUT there are some paperwork that they had to completed before they go. The level of harebrained kooky competency was just staggering! This could have been done well before the transfer time! As it is, the transfer was already delay by one hour from the initial 8 pm timing. They could have asked for all this to be done when my brother-in-law first approached them at 8 pm! Of course this caused a further 45 minutes delay and it was about 9.45 pm when they left Kuala Terengganu. Can you imagine? First of all, the patient just sitting through 5.5 hours of pain and the unknown...just waiting..waiting...the anxiety and dread of every minute that passed for family members praying that the aneurysm not rupture...watching helplessly as she suffer the increasing pain in her head and neck due to the increasing pressure in her brain...It is incredible how some human beings can have so little compassion and empathy for another human being who is suffering and so much selfishness of "wanting to eat"...

The ambulance reached Kuala Lumpur at around 3 am and went straight to the ER. Once again in the usual crap of Malaysia hospital bureaucracy and the seemingly "tidak apa" (can't be bothered) attitude of "I have already seen so many people in worse conditions or dead" my sister was made to wait a mere 2 hours just to get a short of pain meds to help with the increasing pain that she was experiencing. What was worse, the people in the ER didn't see it fit to inform the receiving doctor that the patient had arrived. It was really frustrating and its making us angry. Another 11 hours later, they then wheeled her in to get the much needed cerebral angiogram. As my brother-in-law and sister are both physicians, we were very fortunate that they knew fellow doctors and surgeons at all levels to help speak to the appropriate people and discuss possible options.

This is a snapshot of her aneurysm

In our desperation, we started to look at options in private healthcare particularly in Subang Jaya Medical Centre (SJMC) as someone had recommended a good Interventional Radiologist who is practicing there.  We hit another road block, do you know that is next to impossible to get the medical records, results of tests and whatever scans or x-rays that you have taken? We went on a bootless errand trying to procure the images and CD for a 2nd opinion, only to be told finally that we had to go to the medical records department to fill in a form, pay a sum of money and WAIT! I nearly strangled the doctor I was talking to and snapped back at him saying...wait for her aneurysm to burst? I then calmed down a little and ask where is the location of the medical records department so that I could apply to get the things that I needed? Take a guess what his answer was....of course! The famous "I DON'T KNOW." We needed the CT scan and angiogram CD for the consult.

But God is always in control and has the best plan for us. The short of the long story was that the doctors in the private sector had to assemble their own teams. In this case apart from the Interventional Radiologist, there was also the Neuro Surgery team (in case anything went wrong) and it would take some more time that we didn't have. So we decided to stay on in KLGH and wait for Dr Lau who was coming back from a convention in Singapore who could do the procedure. Lo and behold, he was actually her classmate back in medical school! The surgery was scheduled for Saturday afternoon. She was wheeled in at about 2 pm and it was successfully completed at 2.45 pm. 7 coils were inserted.

He is such a wonderful doctor as he treats all of his patients like his family. He was an extremely humble and down to earth person. Can you imagine that after the procedure he actually went to my brother-in-law and said "thank you for the opportunity to serve you and your family" What an incredible person! People like him really restores your faith in government healthcare!

At this time of writing, I am glad to say that she spent about 3 days in ICU and now been transferred to the ward to recuperate. She is able to walk and move about albeit slowly and carefully. The pain in her head has also reduced significantly.

We are so grateful for God's mercy and love shown to us through so many people who prayed in vigil with us for her healing and recovery. It was indeed a miracle how she condition did not deteriorate into something worse. The aneurysm was on one of the main arteries in her brain and God preserved her life. It was also a miracle how fast all the arrangements were made for her surgery.

I pray a blessing on Dr Lau and his family. Thank you for restoring our faith in the public health care system and thank you for saving my family. 

My last thoughts was of course on how much this procedure would have cost my sister if it happened to her in the US. I also thought about the potential cost we would have incurred had we transferred to SJMC. The indications of it going into the hundred thousands of dollars was actually not a far off estimation. I am so thankful that we were saved from huge medical bills which would have made life that much more strenuous.

I am very thankful that we have public healthcare in Malaysia. It may not be perfect, but when it works, it really works. The other thing that I have come to appreciate is insurance. Medical and travel insurance is definitely a must! Anything can happen at anytime, This incident has really lit a bulb and I am now going to re-look at our coverage for our family.

Thank you once again everyone who prayed in vigil with us, helped in so many ways and made thing just a little easier.

Have you or any of your family member gone through the same thing? Do share your stories, I would love to connect with you. My sister has some way to go to complete recovery.

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