Monday, April 14, 2014

Delayed But Never Denied


Despite my best intentions to pen down my thoughts, time always seem to caught up with me. With so many things to do in so little time.

ANYWAYS, my life now pretty much resolves about caring the newborn baby girl. Yes, the wait was finally over last 6th of February, just three days shy of the estimated due date which also happens to be my birthday. Thus, you (I) could consider this newborn baby girl as my greatest birthday gifts there is. Alhamdulillah.

Gosh there are just so many things happened in between waiting for the bundle of joy till date. I got so  many things rushing through my minds and thoughts that I need to share (record) just for my recollections one day.

1) Labour and Postpartum

First things first, I want to share about the FPP scheme at Hospital Putrajaya. For those unfamiliar with the terms, FPP stands for Full Paying Patient - is a scheme that the ministry of health introduced back in 2007, which offers patient to have services rendered just like in a private hospital i.e. specialists consultation instead of any random Medical Officer or worse rookie doctors aka Houseman Officers! Anyways for more details one can read here FPP Scheme Putrajaya

I started my FPP around 7 months of pregnancy - that is to say I started to see the specialist for the antenatal check-up instead at my regular, local Klinik Kesihatan and Hospital Sg Buloh. Just a anecdotes on my FPP experience though. I got/assigned to Dr. Wan Ahmad Hazim Wan Ghazali, or better known as Dr Hazim, who happens to be the Head of Department (HOD) of OBGN despite my first intention to get a female doctor (under the FPP scheme, only one female doctor available then which was Dr. Hamidah). So for those who wants to know how to register as FPP, one just need to go to the registration counter at the hospital lobby and simply ask for FPP registration (at least that was what my sister told me).

BUT I was nearly DENIED the FPP by the attending nurse - under the reason that "FPP is expensive and costly, I am afraid you can't cope with (the costs) miss.." that was exactly the response I got from the fatty nurse by the way. I mean, how demeaning was her, belittling people and assuming that patients who consciously aware of the FPP scheme to not have them register just because she thinks one cannot afford it??? (on other note, I must have looked pretty darn "selekeh" (read: pauper) to be asking for a FPP eh). Of course that ticked me off - BUT I insisted, and then that fatty nurse tried another excuse that no more specialist doctors are available to which I vehemently objected. In the end, she called the HOD and presented my case, and the HOD said I could have him as the doctor (In fact, I didn't have to wait for my first appointment date, as the HOD asked to see me).

Anyway, that is that. Overall, my review on the FPP is 6.5/10. The breakdowns are as follows:-

A)) On the service (antenatal clinic)

- quite disappointing. I mean the waiting part is just AGONY. To think that you're paying to wait with the majority of others who don't have to pay full payment is just unacceptable. I mean I can't see the point of charging patient for RM110 (every visit) to wait with the rest for more than 2-3 hours even! To me there should be a separate lane/system, to differentiate the full paid patients with the rest.

- again, for RM110 per visit - service is quite dismal. at the front counter of the clinic after the agonising wait, you'll be seeing the nurse who will check your BP and weight (you step on the scale and note the numbers yourself, mind you not the nurse), then depending on the number of people present and perhaps the mood of the attending nurse, she will or will not have an extensive review on you. after which you will be made to wait yet again for your number to be called, which then you need to piss in a urine cup and check for the HB reading yourself (by placing the test strips provided), clean the cups yourself and WAIT again to be seen by the doctor. I MEAN this whole process will be much faster, accommodating and with friendlier nurses if done in a private clinic or even in Klinik Kesihatan / Hospital Sg Buloh antenatal clinic! Again, the thought of paying full payment of RM110 and yet you got to do all the nasty bits yourself, just irks me off.

-finally you get to see the doc. In my case, Dr Hazim, the HOD. again for RM110, the doc's consultation service to you is very...brief. Not to mention no privacy as he would have another HO or MO with him in the room, with most of the time providing some training to them while servicing you (read: his attention to you may not be a 100% and most of time he wanders off). HOWEVER, I must note, that HE IS SUCH A NICE DOCTOR. of course a veteran at the hospital. though i do not know how long he has been a doctor. but the nurses told me he was already servicing at HPJ since its establishment, which was circa 1994-ish.

Ratings for clinic: 4/10

B)) On the actual labour process
So, i was admitted at the HPJ on 4th of Feb. was actually asked to go home (though my doctor instructed me to be warded as I will put on induce meds) -simply because there were no available beds at the supposedly Executive Wards (which is known as Ward 5A- that caters all the FPP patients). That was pure annoyance. I mean I got my maternity/labour bags packed and ready, and I was mentally and physically (although not "anatomically") ready to do all the pushing. Thus before succumbing to the counter's instructions, I went for verification with my doctor and he was shocked and immediately made the call to the front desk and DEMANDED his patient to be warded (as he said he have reserved a bed for me). SO we were back in the game. and off I went (EXCITEDLY) to the much talked about Ward 5A....only to be frustrated, again. I was given a 2 bedded room! BUT MIND YOU you are still charged the premium RM300 per room, regardless. and so now am really pissed. [FYI: even the beds charges at SJMC costs less than that] - and my bed's auto functions was malfunctioned. what a service, what a way to start my "stay" at the exclusive ward 5A (read: sarcasm).

anyway, minutes turned to hours and I still didn't see Dr Hazim though he "promised" to come after his clinic is over. sometime after lunch, then the nurses said he'll come after office hours. and ....yes, you guessed it. HE DIDN'T show up at all. so my first night of RM300 not so-exclusive stay was a "rip-off", in that it was very unproductive, as I didn't feel at all the need to be warded since i don't have the labour pains, not to mention didn't get to see my appointed doctor or ANY doctor to assess my conditions - so unproductive that I felt the need to take a walk around not only the ward but the hospital. yes, i went down and walked around from the labour hall and back to the main building, not only to kill boredom but also in my attempt for a bloody show. BUT alas, I called it a night at 11pm and my hubs went home. BUT I didn't get a good night's sleep as my "roommate" just delivered and her baby was constantly crying (and LOUD). I was part stress because of the noise that infant and her parents make but also stress because that roommate already delivered eventhough we were warded at about the same time, and our babies were about the same age (she was 37+ weeks and I was 39 and this was both our second child). SO first night went by and NO baby. no signs of it at all.

the next day,  i was told that i'll be induced early in the morning by Dr Hazim. so i was looking forward for that. woke up early (at 4am) showered, and got myself ready as ever. only to be disappointed again, that there was no Dr. Hazim, only some normal MO (one of his many proteges i reckon) that showed up and faced my v-jay-jay (literally). He inserted the painless meds and asses my condition at that time: 5th of Feb, 7am - no dilation, no effacement, v-jay jay's soft though aka ripen for delivery. He estimated i'll be in labour in a few hours as the magic meds will do its tricks and i'll get the long for contractions pain. So off i go and waited that....and nurses were coming and going checking my BP , my contractions reading...BUT IT WAS NOTHING till mid-day. They took off the contractions reading straps/machines as I was not showing any signs of labour and postulate i'd on my way for another dose of induce meds by what was then I believe the invisible Dr Hazim. ( as he hasn't turn up despite much promises that he ought as my attending physician).

Lunch time came. Ate the so-so hospital foods. and yes despite my GDM I indulge in everything western menu that is available - of course only to find the taste being compromised or rather "Malaysianised". my spaghetti Bolognese lack ingredients, no parm cheese, and runny sauce and my  mushroom soup has no mushrooms in it. Feeling depressed by the no-labour-signs and dismal food, I was begging my hubs to find me some good food. as the nearest 'civilised' and decent eateries is at Alamanda mall (which is about 20mins from the hospital), i still beg the hubs to get me some, anything from there. one of the nurses agreed that perhaps I should satisfy any 'last cravings' i had that could perhaps fasten the delivery after. So after much contemplation, I came up with an order : Starbucks Macha (green tea) Frappuccino Grande and turkey sandwich. So off he goes, obediently ..yes thank you hubs. this was about 2pm. and suddenly i got a call that my parents were at the hospital lobby with my eldest daughter Hana who was down with high fever yet wanted to see me so bad she was crying inconsolably that my parents had to come and bring her to see me. BUT after the H1N1 plague around 2009 - most hospital impose new stringent rules - no kids under 12 years of age to be allowed in & around the wards. So I had to come down and see them, which i knew was difficult as the nurses denied my requests, pleading requests unless i seek them from my Dr Hazim (the invisible). this was at 3pm and i asked when will i get to see this invisible doctor? so the nurses said he'll come at 5pm to which i replied, "and what if he doesn't? because he promised to come before and never did". and that shut the nurses up. so unconvincingly, i waited for the doc while my hubs was rushing back from alamanda with my starbucks and at around 3.30pm i had a few sips of that cold, sweet frappuccino....and suddenly, i feel some back pains. me thought "oh here comes the contractions?" but i wasn't sure.

meanwhile, my hubs got another drama going - he accidentally misplaced the car keys and was looking all over the place (literally) and with the help of the hospital guards . i mean practically everyone at the lobby know he was "that guy that lost his car keys". and then 5pm, the man i've been waiting for, the name i kept repeating in most of my conversations with anyone about my labour - Dr Hazim, came with his proteges. Cool as cucumber, he "checked" me and just said "ah, am just gonna give a little budge" while two of his fingers were deep in the v-jay-jay. apparently that MO i mentioned earlier didn't insert the meds correctly hence there was no contractions going since 7am. WTF. however, he said that i only 1cm dilated but as if he can read my anxious face, he was like "u really want to go into labour today eh Aishah?" and I silently nod at that. LOL. yes, why not. I mean i've always wanted the birth date to be on the 9th as the same with mine and as the EDD was consistently shown, but if today (5th of feb) was the date for the birth of my child, i thought "yey, same as Norman KRU". LOL. (read: a real KRU bonkers, and Norman in particular of course this was prior to Norman's receding hairlines). anyway, I asked the permission to see my daughter and the doc allowed it. only to asked me to be cautious and use a wheelchair. I thought to myself "pfff, who needs a wheelchair, i am a STRONG woman". but i obliged to his instructions nonetheless. so around 5.30pm i was on my way down to see my daughter who i miss sorely...

HOWEVER as soon as i got down at the lobby, hugged my baby girl Hana, chitchatted a bit, and between the lost car keys drama and suddenly found them, I FELT STRONG, SHARP PAINS. so bad, I was convinced this is the labour pain i wanted so bad. [when i had my first born, i didn't actually get to feel this labour contractions, braxton hicks what not until i was in the labour room, induced and heavily sedated]. the pain was so bad, i knew i was going into labour and asked my dad to wheeled me back to the ward the soonest. i can't even get up. can't cuddle my Hana. so i bid them goodbye. my dad wheeled me back. My hubs found the keys. and that pain continues at regular intervals, longer each time from 6pm. we were so convinced this is it, that I took a small bite of my dinner that night, had my bladder emptied, showered, and jotting down the pains and its duration. BUT no nurses actually heeded this pain, until one nurse came to check my malfunction bed, and saw me bracing through the pain, and convinced i am on my way to labour. so we insisted that she called on my doctor (however unlikely that is) or any doctor for that matter. and as expected, the elusive Dr. Hazim sent another of his protege MO straight from the labour room to check on me. this Dr. (amir or something...) checked and convinced i was 4 cm dilated, consulted Dr. Hazim via phone and Dr. Hazim endorsed me to be pushed to the labour room. so the plot thickens and intensify at about 10pm and i was as excited as i ever can be (and in between pain). yes, me thought to myself. BUT as soon as I arrived at the labour room around 11pm this elusive Dr Hazim still didn't check on me and apparently no one, not MOs and certainly not HOs or nurses will check on FPP patients without the approval of the appointed doctor themselves. lest, you, the patient will be left as be until your own doctor came or any approved MO by him/her.

Finally, an entourage of perhaps rookies and MOs stormed my room 6 at the labour theater, and checked on bunch of things - including the dilation & effacement. still 4cm so they said. and I was told to take the epidural. of course i hesitated on this, i wanted to be free from drugs and feel the pain this time. i took the pain fine the last time, so this time it shouldn't be any problem. but another part of me, wanted to try this much talked about, extra charges on your bill - epidural drugs. so after a brief consultation with one of the MOs there, talked about risks and after effects although i was partly irritated by his remarks which seemingly subconsciously implying me that i 'm some dumb, dinosaurs-trapped-era, mediocre, uneducated housewife with his "ala this epi procedure is so normal (like this is the 21st centuries), people do it and take it so often, it's so common that they are practically not risky anymore" with a very cold (not to mention handsome, young) face. ((intermission: suddenly i found myself transported back in time when i had my first surgery in 1999 with that oh-so-handsome Dr Faizal of HKL, yes I remembered his name and face too...and with all that Noah Wyle likes in the hit series ER scenes flashing off in front of me while this particular episodes of my life took place)). A few minutes later, i find myself signing the agreement for EPI letter and a MD anesthesiologist came and explained in full and very calmly the procedures that i am about to embark.

Soon, I found myself ready for the epi insertion. Must confess, I am quite scared as this involves your spine. Honestly I was imagining the many "what ifs" ...such as "what if this goes wrong?" or "what if I came out from this epi and paralyse?"...and all other scary scenarios playing on my mind. BUT it was too late to back out from the decision as the doctor prep my back for the hair-thin needle insertion in the spine. A look at the clock and it was already about 1am and am told i was still only 4cm dilated. Although at this point my contraction was strong (and I could still feel the pain) but there wasn't much action happening down there. Finally, the elusive Dr Hazim came by to see me at around 1pm. Checked the v-jay-jay and confirmed it's still 4cm. He asked me nonchalantly if i was in any pain. to which i answered "NOPE. Nothing". of course the EPI drugs was already in effect. and he was happy to hear my answer. "yes, that's the whole point of having Epi drugs - u don't feel the pain". however, what came next was shocking to me.

he said "well alright, I'm off now. You can go to sleep. try to sleep and get your rest". while walking out from the labour room leaving me in gasp. I couldn't answer as fast as i wanted to. I was shocked. Did I hear this doctor right? why does he ask me to go to sleep? shouldn't i be pushing this baby out? what's happening....and million other questions racing in my mind. and just like that, the doctor left me be again. I am almost confident he is an invisible man (read: sarcasm). luckily there was one nurse there and i seek her verification on the matter about dozing off in the room. in the LABOUR ROOM. sleep? doesn't sound right. BUT she confirmed, again, nonchalantly that i should get some sleep, or it will take awhile for the birth. how can she knows this?how can she be sure of this? there must be some kind of's as if they 'drugged' you and left you in veggied mode and sleepy, and they're off to take some naps or coffee breaks. 

BUT that was that. I was getting sleepy yet anxious. and I don't feel much of the pain anymore. My contractions was still regular and strong however at this stage, my baby was dozing off too. and this raise the concerns of the attending MOs who took charge of things (since the elusive doctor went home! so i was told). and so in between the pain and sleepiness, there were MOs or nurses coming in and out from the room checking the baby's heartbeat and sometimes asking me to reposition myself as to wake the baby or at least keep her active. i am told this could be one of the effects of the Epi drugs too - your baby in the womb is also sleepy!

anyways, I SLEPT every now and then dozed off. and soon it's 6am. told my hubs that perhaps after Shubh adzan the bubs will want to go out. so asked my hubs to prep himself, went to pray Shubh. those graveyard hours before I woke up, were very quiet suddenly became noisy again with the stream of new shift staffs clocking in. and there were new MOs too checking me. and boy, am already 8cm dilated! I was like "whattttttttttt?" why didn't i feel anything. and the excitement was back again. told hubs, this is it. but my elusive doctor still didn't come in. the MOs and nurses were getting ready. they are convinced that I'll be giving birth anytime soon as am already 8cm. that's huge progress. and so by 7am, I saw my elusive doctor again, all primp and refreshed. he was his chirpy self as always though. chirpy but relax and cool.

Dr Hazim: So Aishah. how are you? Tidur cukup? Dah ready? Doktor check sikit ye.
Me: Tidur. Ngantuk. Da berapa cm saya?

and he poked me.

Dr Hazim: mmm, dah tak lama dah. sekejap je lagi. awak da 9cm. Doktor pecahkan air ketuban ye.

and he calls his team to prep. oh my oh my. just like that, in less than an hour am about to push the lil bubs out into this world. and from then on, everything went so fast. a team of MOs, nurses came in to assist the doc. and the doc poke the amniotic sac and i was off for the big push. BUT i didn't feel any pain, except the urge to excrete my bowel. the nurses were half panicking. "that's the cue. u feel like u want to make a big poo poo".  they propped up me legs and the doctor instructed me to take a deep breath, hold and give a mighty push everytime i feel the contractions. BUT there was a problem. I don't feel the contractions. as I was on epi. so there were two nurses supposedly on watch for that contractions (with their palms on my tummy to see if it's hardens - then that would be my cue to push). and so i push and push while all the way the Doctor was praising and guiding everytime. which i find soothing....i was pushing hard with my hubs next to me taking the roleplay as "pompom boy" cheering me on, encouraging me, and when i push hard and right on cue, i got praises from the nurses too. i felt like i was on a marathon, trying to get to the finish line. am so convinced i'd make it....UNTIL..........

Dr Hazim: Aishah, push Aishah. Tarik nafas push...cepat Aishah sikit lagi. Baby awak da stress ni..

when i heard that my baby was in stress, that pulled me back. I got scared. I pushed my hardest but somehow it wasn't enough.

Dr Hazim: Aishah, push hard. kalau tidak doktor kena bantu awak.

and that one last deep breath, with my hubs cheering me and giving support saying the baby's head could be seen, i just need to give one last i did. but it wasn't good enough apparently and so the doctor helped the birth and used a vacuum. I heard the doctor's disappointed grunt while using the tool. I felt like a loser. I lost the marathon. I felt awful. I felt sorry for my baby that she needed to be vacuumed out which would leave marks on her tiny, soft head. BUT I was tired. I didn't have the energy. or perhaps I wasn't doing it right. the doc congratulated me and showed me the baby (but didn't placed her on the tummy like they did with my first born the last time at this same hospital). My hubs said "good job mommy". and he was pleased. he was happy. i was happy that the ordeal was over. and next was the stitching/sutures. i must've ripped my v-jay jay, oh how i worry i ripped it off. the last time my postpartum experience was horrible. the sutures was horrible, and i had to lived with the pain for quite some time. and so i was hoping real bad that my doc will do his best with the sutures. as i was still on epi, i couldn't feel a thing yet very conscious to see his serious face in between my legs stitching me up. he even scolded his rookie, a MO for not focusing in this live "tutorial", practically called her off when she didn't sponge /wipe off the blood. anyway, i felt reassured. and felt this time around the stitches will be awesome. (read: last time i had some rookie stitched me up or lack of stitching that is).

anyway, kudos to Dr Hazim though elusive and invisible yet cool as cucumber and the finest of doctor i've had the privilege of service.

so lil bubs was delivered at 8.53am, weighing 2.70kg, height 51cm, head diameter 33cm.

but just when things were all done with me, i still didn't get to see her and nurse her till about 2 hours later. i was told they put her in an incubator to help her lungs breath in the oxygen. perhaps all weary and stressed from the whole traumatic womb-to-world journey, she couldn't breath well. BUT alhamdulillah. i got her on my hands hours later, and nursed her. and baby and mommy was doing great.

was back at my ward by noon. starving like hell. then to my utter disappointment, i was still placed in the two-bedded room, though i was next in line for a single room (prior me leaving for labour). so that pissed me off. after much quarreling and arguing here and there (malas nak pour in the details menyakitkan hati sahaja), I got the much waited room transfer at 7pm. so we spent the night in the single room. and was discharged the next day (7th of february at 12pm).

Ratings for Dr Hazim: 8.5/10
Ratings for ward service: 2/10
Ratings for ward food: 5/10
Ratings for ward nurses: 2/10 (strictly for all the evening nurses on that 6th feb, mostly rude and cold and unaccommodating).

total damage costs: RM2990. (note: most charges incurred for the stay, i stayed 4D3N - rm300 per day & epidural & after hours doctor's visit).

OVERALL: I'd recommend this FPP scheme for anyone who seeks government hospital service but are not government servants. HOWEVER if you do have money to splurge (maximum RM10K) for delivery, you'd better go for any private hospital. As for me, would I go for this FPP scheme again if i ever have another baby? - perhaps. depending on the financial situation. Preferably I'd go for other established private hospital and so i'll need to save for that but if the moolah situation about the same as this experience, i'd probably go for Selayang Hospital FPP. or why not, again for this FPP and under Dr Hazim again. because the hospital has my health records and the doctor am familiar with. He was a pleasant and good doctor and thanks to him in the first place, I didn't have to get insulin for my GDM as instructed by the mediocre, rookie government clinic's doctor I previously attended to before changing all my appointments to FPP HPJ.