OUR PRECARIOUS LIFE

It was 1.45pm yesterday. I was taking a respite after settling a number of cases, in and outpatients. Shidah, the staff-nurse called for me albeit in a casual way and I assumed it was a non-urgent case. Thus I approached the patient who was lying on the bed and asked the male attendent for any info about her. In a relaxed manner he said, "alaa, perempuan ni, dia orang jumpa pengsan tepi jalan.." I took a quick glance at her and immediately I percieved that she was gasping and her breathing was markedly erratic. "My goodness! She's gasping!" Grabbing the torch-lite, I checked for her pupillary response: Right side fixed and dilated (full-moon) and the left side was 4 mm and sluggish. "Call for code-blue!" I shouted. Calling for code blue means that staffs(code blue team) who are trained to handle emergency/ resuscitation from other floors and departments are to come straight away/stat to the A and E.

In an instant everyone started moving frantically. I demanded the ambu-bag and ordered that the patient be masked and bagged (oxygen 10 litres/min). As the patient was still breathing on her own although erratically, I ordered the nurse to synchronize the bagging with the patient's breathing or the effort will be futile. I managed to set an I/V line in her right arm and started running a pint of Hartman's. At the same time, another I/V line was installed in the other arm for drug infusions.

A swift examination revealed a hematoma and laceration on the occipital region. There were also two small hematomas on the forehead.

The patient was still unconscious. I took over the bagging and demanded the nurses to prepare equipments for intubation and check the ECG leads. The ECG rythm was tachycardic but still in sinus rythm. Her blood-pressure was 90/60. There was blood coming from her mouth.

"Call the surgeon and anaesthetist stat!" I ordered . Meantime, we prepared the patient for an urgent brain-scan and group-cross-matched 4 pints of whole blood. In between resuscitation, I managed to retrieve history regarding the patient. Apparently, patient was brought in by a passer-by who found her sprawled, unconscious on a back alley, surrounded by onlookers. The good samaritan carried the lady into her car and drove her straight to the A and E.

Each time when we face such a case in the A and E, with unknown cause of unconsciousness relating to head injury, we have to consider the possibility of cervical spine fracture. Thus stabilization of the neck is crucial. In this case we used a cervical collar. Another important diagnosis to be looked into is fracture of the base of skull which if not properly handled will worsen the condition especially during forced intubation.


The patient was transfered to the ICU, intubated and on ventilator. The brain-scan showed fracture of the occipital bone extending to base of skull. There was a huge subdural hematoma causing a midline shift. Her BP crashed and she was supported with adrenaline and dopamine infusions. She continually bled from her mouth and the endotracheal tube and continuous suction had to be done. Blood was transfused.

This is a sad story of someone whom just 24 hrs ago was living her life unassumingly. As her husband had died a year ago of leukemia, she had to make ends meet to support her 2 children (8 and 9 yrs old) and an elderly mother. To top it all, she was diagnosed with SLE.

On that fated afternoon, she had just withdrew money from the ATM machine and was walking towards her car in the small alley when a theif on motorbike snatched her bag. Whilst struggling she lost balance and fell, hitting the hard cemented pavement. She never regained consciousness.

I took her photo in sadness. She is fighting for her life which the visiting Neurosurgeon postulated only 40% chance of survival rate even if surgery is attempted in view of the massive hemorrhage. I can't bear watching her two small kids cry over her. It's truly heart-wrenching.

Maybe this can be a lesson for us to be extra, extra careful. Avoid lonely alleys. Withdraw money from ATMs with friends and not alone. It's probably better not to struggle with a snatcher and avoid head-injuries. After all what's a few hundred ringgits compared to dear life. And to all snatch-thieves out there: stealing is one thing but to take another person's life? Is it worth it?

Balakot: A Lesson to learn part 3

Morning view along Karakoram highway

Allama Iqbal Airport is a new Lahore airport. Built to cater more international flights. A beautifully designed airport but not busy. Lahore is in Punjab Province in the Northen part of Pakistan, a few km away from India-Pakistan border; Wagar Border/ Amritsar.

Eager young volounteers at the disaster site in Balakot

The first thing that attracted me when entering Lahore is the horses/mules. In Lahore not only do they use rickshaw (equivalent to the tut-tut in Thailand) but also horses and mules.

Injured and Homeless; Balakot

Lahore is far more beautiful than it used to be 25 yrs ago when I first set foot there. It used to be very smelly with horses’ waste but now the smell is not that obvious.

Unwanted donations: Walking through heaps of unsable clothes at Balakot

At the airport the official exchange rate was Rp 15.8 to RM1 but we were only given Rp 15 to RM1(make a guess where the Rp 0.8 went to). We got our things and told Jamal (the Malaysian student) that we were hungry. The time was about 11.45 pm and the expected time of departure at Lahore Daewoo terminal was 12.30 am. We got a taxi and drove straight to Daewoo Bus Terminal. We started to search for restaurants or stalls but none was open. We checked our luggage and after revaluating the time, we took a ride on a rickshaw to a nearby restaurant.

Landslide at Naran Road, half blocked. I travelled along this road almost daily visiting a camp at kilometre 15. The camp was operated by Al Khidmat, a local NGO.

Collapsing mountainous Naran Road; accessable up to 15 km only.

Observing Jamal negotiating the rate with the rickshaw driver made me recalled 25 years ago how my sister bargained to get a good price with their head shaking left and right just like the Pakistani do. Jamal even cupped the drive’s cheeks, like an adult doing it to a child ‘to say how cute you are.’ They agreed to the price eventually.

The restaurant in Lahore where we had our dinner

We entered Fazal-E-Haq Restaurant and ordered 4 plates of chicken biryani. The rice was served with chicken masala, mashed spinach and tomato with onion salad. It was a fast dinner and we got back to the bus terminal 5 minutes before departure, had our luggage tagged and boarded into the luggage compartment, ticket checked, scanned with a portable metal detector and our face recorded with a videocamera at our seats. The bus left the terminal at 12.30 am sharp. Yes we were boarding a bus! Not an airplane, mind you!

Kalahar Daewoo Rest area.

A few minutes after departure, we received a welcome note from our ‘stewardess’. She had a sweet voice, starting with the doa and announcement in both Urdu and English. We were informed of the duration of the journey, expected time of arrival, our next stop and the refreshments that will be served. We were given head phones, sandwiches and drinks. Our next stop was Kalahar Daewoo Resting terminal.

Homeless Pashtun kids posing at our camp; Their houses in the mountains were destroyed by the 8th October Earthquake. They loved to be photographed.

Balakot: A Lesson to learn part 2

A space at Bangkok Airport where we prayed

We proceed to Gate 32 and had to stop for security check. The irritating buzzing sound triggered as I walked through the scanner indicating the presence of metalic object. A body check was performed and I was glad that it was fast and simple using a hand scanner. Haji Hani was not so lucky. He was screened by a lady officer with the hand scanner and hand searched for concealed contraband. "Damned it! She touched my chest and it was ticklish," he complained. :)

Mansehra-Balakot Road; Dr Hassan, Hj Hani, Dr Azmi

We boarded Thai Airways inbound to Lahore at 8.30 pm but due to unavoidable circumstances, our flight was only allowed to depart at about 8.50 pm, a 20 minutes delay. The cabin was quite hot and we were sweating. Most of the passengers were Pakistani, Thailand foreign workers returning home for Eid. They were nicely dressed with a number wearing blazers with ties.

It was getting hotter and some passengers were already using newspapers or magazines as fans. The cabin odour was getting stronger and unpleasant. Everything changed after we took off. It got cooler and we were given warm towel to wipe our oily face and sweaty hands. It was 30 minutes later when the long awaited meal were served. Since we had a light iftar at Bangkok, our stomach had started to grumble. What we were worried of was 'what if we could not get halal food as we had requested before departure?' We leaned forward, peeping at the front seat passenger when he was served with a specially requested food, a 'Non pork meal' written on the box.

Grinning, I told my friends, "Non pork doesnt mean its halal. It may be chicken or cow slaughtered by non Muslims."
The steawardess continued moving, pushing a fairly big container-trolley filled with prepared meals asking politely to the passengers, "Chicken or fish sir? Maam?"
Then came our turn and after looking at a check list, she started to prepare our meal. On the box was clearly written 'Muslim meal'. We looked at each other smilling, as it was prepared according to our request. Most of the passenger just took the standard prepared meal without asking its origin.

We finished our chicken biryani, had our coffee and my newly recharged mind started to wonder, "Have anybody seen that Pakistani boy, friend of Mahmud? He is supposed to be in the same flight."
Nobody saw him. He could not have missed the flight since we were told that the boy would be checking in a few minutes later. It was not the same case as what had happened to Mr Mahmud other friend who missed his plane forcing Mr Mahmud to wait for the next flight that should be arriving at 5.00 pm.

Mr Mahmud and his Malay friend was supposed to go on business trip together in Bangkok that evening. Anyway his Malay friend did not turn up. Now, his Pakistani friend too disappeared into thin air, nowhere to be seen, not in flight nor at Lahore.

Damages at Muzaffarabad

We managed to get a short sleep before arriving at Allama Iqbal International Airport, Lahore at 10.00 pm local time. We just follow the crowd and queue at the foreigners line. The officer at the counter seemed very detailed with her questions causing a long wait. After 15 minutes waitaing in the hardly moving line, we were then ushered to the Pakistan Passport lines that were emptying fast. Then only we noticed that there was a special counter for the earthquake relief volounteers like us. We moved to the counter and were bombarded with questions, not only by the lady officer from the counter but also from another male officer that suddenly turn up since I told them that i was the head of the group.

We had to fill forms, special entry forms asking what sort of aid we will be giving, our destination, our local address and our expertise. The male officer then asked for my pen to write someting on my entry form. It was a nice green pen given to me by a medical company back home. I expected the pen to be given back to me, but alas, NO! He gave it to the lady officer, wicked smiles in their faces and than she placed it carefully on the right side of her computer keyboard. She lifted her 'i knew nothing face' and told me, "Thank you sir, you may proceed." Knowing these people, I just kept quiet, not bothering to ask or saying good bye to my pen.

Naran Road; They had to walk more than 15 km

I had been to Pakistan before, way back in 1980. I visited my sister who studied in a college taking A-Levels at Karachi. She stayed at Jayker Road which reminds me of a book 'The Jackal', not the classic 'Dr Jaykell and Mr Hyde'. She was not on vacation during my visit, so I opted on her suggestion to travel and visit other Malaysian students in Lahore, 1000 miles away. I took 'Shalimar' Express, a superfast train that arrived at Lahore 14 hours later. A super express will take you 18 hours, normal train 24 hours and a combo train somewhere 36 hours. I then travelled by myself to Amritsa, Jammu, Sri Nagar and New Delhi which took me one whole week.

Balakot; Brotherly love. Parents victim of 8/10/2005 earthquake

We then proceed to get our baggages; rucksacks, boxes filled with equipment and medicines. We were stopped half way and more questions asked, "Why are you here? What sort of aid are you going to give? Where are you bound to? How many days will you be staying? What do you have with you?"
Satistied with the answers, we were then allowed to get our things and proceed to queue to have our things X-Rayed. We had to pass through the customs counter which allowed us to move unchecked. "You are from the relief mission? Malaysia?" An officer asked.
"Yes." I nodded.
"Good, welcome and you may proceed," answered the officer.
At last! There was someone that can appreaciate our effort, and it reminded me of my father in law, a retired high ranking non corrupted custom's officer.

Balakot; Treating an injured girl

A Malaysian student was there waiting for us once we were outside the custom check point. Brother Jamal had just finished his Islamic Studies final examination and was preparing for home. Our collegue, Brother Iqbal had arranged for Brother Jamal to meet us and board us on a bus to Abbotabad in the North Western Frontier Province the same night.