By Dr Vanessa Tan
Year 4 Otorhinolaryngology Resident

*All names have been changed to protect the privacy of the patient

Mr Gary Lim* had severe burns affecting 60 per cent of his body and a tracheostomy (an incision in the windpipe to aid breathing). His arms and body were wrapped in dressings, his eyes were swollen, and his face reminded me of Frankeinstein. 

Today, I had to change his tracheostomy. When I explained the procedure to him, he tried to gesture with his wrapped arms and lips.

“Is it going to be painful?”

I assured him that he would only experience some coughing, but it would not be painful. He did not seem very convinced, but this was a job I had to do before carrying out the many other tasks awaiting me.

Although the change of the tracheostomy was pretty uneventful, Gary did cough frantically for a good five minutes till his face became red (I didn’t think it could get redder than it already was, but it did).

He gestured again, “I cannot breathe.”

The oxygen probe read 100 per cent and I assured him once again.

“Things are okay.”

I quickly left him thereafter, not only to carry out the many other tasks, but perhaps to also escape from that tiny voice in my head.

I had betrayed his trust by telling him the procedure would be straightforward, and how it wouldn’t cause him to feel like he was going to die, gasping for air. 

Come midnight, the nurses called me to set an IV plug on Gary.

I argued that he already had a central line, and it doesn’t make sense to set a small plug on him so that he can go for his procedure the next day.

The nurses said, “That is the protocol.”

I grumbled beneath my voice, “These protocols don’t make sense.”

Although Gary’s IV plug was going to be a HUGE challenge (considering most of his skin is burnt and my aiming skills aren’t the best at midnight), holding a debate about why he doesn’t need the IV plug did not look very promising.   

Gary was asleep, with his radio playing in the background. I woke him up and explained that he needed an IV plug.

He gestured, “Why do I need it? It’s going to be painful.”

I brought his fingers to his newly-changed tracheostomy tube and told him that he can now speak with the new tube. He struggled to do so, as his arms were heavily bandaged. He was physically too helpless to resist, although his mind and facial expressions desperately tried to.

I applied a tourniquet (a compression device) to his leg, assuring him that I will get the plug with the least amount of discomfort, and that he really needed this plug. 

First attempt failed. Second attempt, and to my relief, the plug was in.

I felt pretty proud of myself. After all, I hadn’t had that many attempts to set a plug on this man.

Gary tried to speak to me once again.

I thought, “He is going to thank me for being so swift with the IV plug, for setting the least painful plug ever since his admission.”

This time, I helped him occlude the tracheostomy tube better so that he could speak. He said in Mandarin, “You woke me up, and it’s very difficult for me to fall asleep.”

Our patients are sometimes caught in very vulnerable situations. They are the ones who can’t move as we repeatedly poke them with needles or perform invasive procedures on.

The burnt patient, the stroked-out patient, the demented patient, the bed-bound patient or the anaesthesised patient – they can’t voice their pain. They can’t push us away.

Perhaps tomorrow I will go into Gary’s room – not to administer some invasive painful procedure, but to spend a little time with him and ask him how he has been.

Hopefully, his third encounter with me will be more pleasant than the previous two.